Local anaesthetic systemic toxicity — FRCA Primary MCQ

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HardPharmacologyLocal anaesthetic systemic toxicityFRCA Primary

A 23-year-old patient develops circumoral tingling, tinnitus and agitation after an ultrasound-guided axillary block with bupivacaine. The ECG then shows broad complexes and hypotension. Which drug is most appropriate as a specific rescue therapy?

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Correct answer: B — Calcium chloride

This is local anaesthetic systemic toxicity with neurological symptoms followed by cardiovascular instability; intravenous lipid emulsion is the specific rescue treatment alongside standard resuscitation. Sodium bicarbonate may be considered in some sodium-channel blocker toxicities, but it is not the primary specific therapy here. Flumazenil does not treat local anaesthetic toxicity. The pearl is to recognise early neurological symptoms before cardiovascular collapse.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia