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Local anaesthetic systemic toxicity — FRCA Final MCQ

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HardRegional AnaesthesiaLocal anaesthetic systemic toxicityFRCA Final

A 54-year-old woman receives an epidural bolus of 0.25% levobupivacaine after open colectomy. During injection she develops perioral tingling, tinnitus and light-headedness; the ECG then shows broad-complex tachycardia and systolic blood pressure is 70 mmHg. What is the most important next step?

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Correct answer: C — Stop injection and start 20% lipid emulsion therapy

The neurological prodrome followed by cardiovascular collapse during local anaesthetic injection indicates local anaesthetic systemic toxicity. The injection must be stopped, airway and seizure management started, and intravenous lipid emulsion given according to the severe LAST algorithm. Verapamil and further local anaesthetic are hazardous. The pearl is that intravascular epidural catheter migration can occur after previous satisfactory use.

Reference: Association of Anaesthetists severe local anaesthetic toxicity guideline 2023