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. 2019 Jun 28:12:193-197.
doi: 10.2147/IMCRJ.S207317. eCollection 2019.

Successful intralipid-emulsion treatment of local anesthetic systemic toxicity following ultrasound-guided brachial plexus block: case report

Nguyen Trung Kien  1 , Nguyen Truong Giang  2 , Bui Van Manh  1 , Nguyen Manh Cuong  3 , Ngo Van Dinh  3 , Dinh Cong Pho  4 , Vu The Anh  3 , Dao Thi Khanh  5 , Luu Quang Thuy  6 , Pham Van Dong  7
Affiliations

Successful intralipid-emulsion treatment of local anesthetic systemic toxicity following ultrasound-guided brachial plexus block: case report

Nguyen Trung Kien et al. Int Med Case Rep J. .

Abstract

Background: Local anesthetic systemic toxicity (LAST) is a life-threatening complication that may follow application of LAs through various routes. Despite increasing usage of LA techniques in a large number of health-care settings, contemporary awareness of LAST and understanding of its management are inadequate.

Case presentation: We report two cases who suffered LAST following brachial plexus block for surgery on the upper extremity. The first patient received an ultrasound-guided supraclavicular block with 300 mg lidocaine (6 mg/kg) and 50 mg ropivacaine (1 mg/kg) in 25 mL without epinephrine, and the second patient received an ultrasound guided interscalene block with 200 mg lidocaine (4.5 mg/kg) and 45 mg ropivacaine (1 mg/kg) supplemented with epinephrine 1:200,000. Both patients presented with symptoms of central nervous and respiratory system depression, the first roughly 10 minutes after injection, and the second immediately after withdrawal of the needle. In both cases, thorough recovery was obtained using lipid-emulsion therapy.

Conclusion: The complication of LAST following ultrasound-guided brachial plexus block could be treated successfully applying the American Society of Regional Anesthesia and Pain Medicineprotocol of intravenous administration of lipid emulsion.

Keywords: lipid emulsion; local anesthetic system toxicity.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

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