Local anaesthetic toxicity is rare but life-threatening. Most deaths from local anaesthetic toxicity have been due to the inadvertent intravenous injection of a toxic dose of local anaesthetic.  Rapid recognition and appropriate treatment saves lives.

Please monitor pain and nausea score and look for signs of toxicity as follows:

• In Recovery: Every 15 mins
• On Ward: Pain, nausea, sedation and signs of toxicity should be performed hourly for 4 hours,
• then 4 hourly if the patient remains stable.

Pain, nausea and sedation to be recorded on NEWs chart.

Signs of toxicity and system check to be recorded on local anaesthetic chart.

• Only the dedicated local anaesthetic pump may be used.
• Routine post operative care should be given, unless instructed to do otherwise by the Anaesthetist.
• Patients with a brachial plexus block should have their arm secured in a sling.
• Ensure a patent IV cannula is in situ, whilst the local Anaesthetic Infusion is in progress.

If any of the signs and symptoms of local anaesthestic toxicity are present:

• Clamp the wound infusion device line.
• Contact the ITU Anaesthetist urgently
• Administer Oxygen 10 L/minute via facemask if O2 Sats < 95%.
• Call for help and initiate CPR procedures if the patient is apnoeic. Call 2222.
• Obtain Lipid rescue bags: ClinOleic 20%, stored in surgical HDU, pharmacy cupboard, theatre corridor (bleep 1089 for access) and labour suite and commence as soon as possible.

Treatment of local anaesthetic toxicity is likely to have a good outcome if toxicity is recognised and basic resuscitation is started early. The basic tenets of treatment are:

• prevent hypoxia which will cause brain damage and make fitting or arrhythmias more difficult to control
• treat hypotension and arrhythmias early
• ensure that fits are adequately treated
• most reactions are short-lived if the above advice is followed.
• Lipid rescue bags: ClinoOleic 20% stored in SDHU cupboard, pharmacy cupboard, theatre corridor (bleep 1089 for access) and labour suite