Skip to main content

Advertisement

SpringerLink
Log in

Local Anesthetic Systemic Toxicity (LAST) – a Review and Update

  • Regional Anesthesia (P Kukreja, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article reviews the incidence, presentation, risk factors, and treatment for local anesthetic systemic toxicity (LAST). We have specifically focused on the changing patterns in practice, presentation, and recent updates on treatment.

Recent Findings

Regional anesthesia is now an essential component of perioperative care with enhanced recovery programs, multimodal analgesia regimen, and the opioid crisis. Local anesthetics are widely used, contributing to varied presentations and increased incidence of LAST outside the operating room. Use of intravenous lipids for treatment of LAST has increased, but there is still deficiency in timely, appropriate use. Recent studies have given us a better understanding on the mechanism of action of lipids.

Summary

LAST though rare continues to happen in different patterns and locations. Updated knowledge is required to prevent and manage this dreadful complication. Anesthesiologists can lead in training and educating others, in prevention and management of LAST.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 2017;42(2):133–83.

    PubMed  Google Scholar 

  2. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.

    CAS  PubMed  Google Scholar 

  3. Chin KJ, Pawa A, Forero M, Adhikary S. Ultrasound-guided fascial plane blocks of the thorax: pectoral I and II, serratus anterior plane, and erector spinae plane blocks. Adv Anesth. 2019;12:187–205.

    Google Scholar 

  4. Blanco R, Ansari T, Riad W, Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41(6):757–62.

    CAS  PubMed  Google Scholar 

  5. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum blockanatomical concepts, mechanisms, and techniques. Anesthesiology 2019;130(2):322–35.

    PubMed  Google Scholar 

  6. Gupta A, Sondekoppam R, Kalagara H. Quadratus lumborum block: a technical review. Curr Anesthesiol Rep. 2019;9(3):257–62.

    Google Scholar 

  7. Sinha SK, Clement A, Surette A-M. Infiltration between the popliteal artery and capsule of the knee (iPACK): essential anatomy, technique, and literature review. Curr Anesthesiol Rep. 2019;9(4):474–8.

    Google Scholar 

  8. Weiss E, Jolly C, Dumoulin J-L, Meftah RB, Blanié P, Laloë P-A, et al. Convulsions in 2 patients after bilateral ultrasound-guided transversus abdominis plane blocks for cesarean analgesia. Reg Anesth Pain Med. 2014;39(3):248–51.

    CAS  PubMed  Google Scholar 

  9. Barrington MJ, Weinberg GL, Neal JM. A call to all readers: educating all surgeons on preventing and treatment of local anaesthetic systemic toxicity. ANZ J Surg. 2016;86(9):636–7.

    PubMed  Google Scholar 

  10. Butterworth JF, Strichartz GR. Molecular mechanisms of local anesthesia a review. Anesthesiology 1990;72(4):711–34.

    CAS  PubMed  Google Scholar 

  11. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90–102.

    PubMed  PubMed Central  Google Scholar 

  12. Di Gregorio G, Neal JM, Rosenquist RW, Weinberg GLM. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med. 2010;35(2):181–7.

    PubMed  Google Scholar 

  13. Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78(5):507–14.

    CAS  PubMed  Google Scholar 

  14. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29(6):564–75.

    CAS  PubMed  Google Scholar 

  15. Lirk P, Picardi S, Hollmann MW. Local anaesthetics: 10 essentials. Eur J Anaesthesiol EJA. 2014;31(11):575.

    CAS  Google Scholar 

  16. Catterall WA. Voltage-gated sodium channels at 60: structure, function and pathophysiology. J Physiol. 2012;590(Pt 11):2577–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Verlinde M, Hollmann MW, Stevens MF, Hermanns H, Werdehausen R, Lirk P. Local anesthetic-induced neurotoxicity. Int J Mol Sci. 2016;17(3).

  18. Butterworth JF, Brownlow RC, Leith JP, Prielipp RC, Cole LR. Bupivacaine inhibits cyclic-3′, 5′-adenosine monophosphate production a possible contributing factor to cardiovascular toxicity. Anesthesiology 1993;79(1):88–95.

    PubMed  Google Scholar 

  19. • El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018;11:35–44 A review article discussing relevant pharmacology, risk factors and management of LAST.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Mulroy MFMD. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. [editorial]. Reg Anesth Pain Med. 2002;27(6):556–61.

    CAS  PubMed  Google Scholar 

  21. Neal JM, Bernards CM, Butterworth JF, Gregorio GD, Drasner K, Hejtmanek MR, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):152-152–61–61.

    PubMed  Google Scholar 

  22. •• Gitman M, Barrington MJ. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43(2):124–30 This is a review of case reports, and online registries of local anesthetic systemic toxicity between 2014 to 2016.

    PubMed  Google Scholar 

  23. Groban LMD. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med. 2003;28(1):3–11.

    CAS  PubMed  Google Scholar 

  24. Wolfe JW, Butterworth JF. Local anesthetic systemic toxicity: update on mechanisms and treatment. Curr Opin Anesthesiol. 2011;24(5):561.

    Google Scholar 

  25. Guinet P, Estebe J-P, Ratajczak-Enselme M, Bansard J-Y, Chevanne F, Bec D, et al. Electrocardiographic and hemodynamic effects of intravenous infusion of bupivacaine, ropivacaine, levobupivacaine, and lidocaine in anesthetized ewes. Reg Anesth Pain Med. 2009;34(1):17–23.

    CAS  PubMed  Google Scholar 

  26. Sites BD, Taenzer AHM, Herrick MD, Gilloon C, Antonakakis J, Richins J, et al. Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry. Reg Anesth Pain Med. 2012;37(5):478–82.

    CAS  PubMed  Google Scholar 

  27. Liu SS, Ortolan S, Sandoval MV, Curren J, Fields KG, Memtsoudis SG, et al. Cardiac arrest and seizures caused by local anesthetic systemic toxicity after peripheral nerve blocks: should we still fear the reaper? Reg Anesth Pain Med. 2016;41(1):5–21.

    PubMed  Google Scholar 

  28. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38(4):289–99.

    PubMed  Google Scholar 

  29. Heinonen JA, Litonius E, Pitkänen M, Rosenberg PH. Incidence of severe local anaesthetic toxicity and adoption of lipid rescue in Finnish anaesthesia departments in 2011–2013. Acta Anaesthesiol Scand. 2015;59(8):1032–7.

    CAS  PubMed  Google Scholar 

  30. Italian Registry of Complications associated with Regional Anesthesia (RICALOR). An incidence analysis from a prospective clinical survey. Minerva Anestesiol. 2016;82(4):392–402.

    Google Scholar 

  31. • Rubin DS, Matsumoto M, Weinberg G, Roth S. Local anesthetic systemic toxicity in total joint arthroplasty: incidence and risk factors in the United States from the National Inpatient Sample 1998–2013. Reg Anesth Pain Med. 2018;43(2):131–7 This is a large retrospective study using a national database, analyzing local anesthetic toxicity in patients undergoing total joint arthroplasty. Over 700,000 patients who had a peripheral nerve block for joint arthroplasty were included in the study that covered over 15 years.

    PubMed  PubMed Central  Google Scholar 

  32. • Mörwald EE, Zubizarreta N, Cozowicz C, Poeran J, Memtsoudis SG. Incidence of local anesthetic systemic toxicity in orthopedic patients receiving peripheral nerve blocks. Reg Anesth Pain Med. 2017;42(4):442–5 This is a retrospective analysis from a database for joint arthroplasties. It discusses the changes in incidence of LAST and the use of lipid emulsion for treatment over a period of eight years.

    PubMed  Google Scholar 

  33. •• Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG, Mörwald EE, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: executive summary 2017. Reg Anesth Pain Med. 2018;43(2):113–23 This is a practice advisory from ASRA with updates on incidence, risk factors, prevention and management of LAST and discusses the changes since the previous advisory in 2010.

    PubMed  Google Scholar 

  34. •• Gitman M, Fettiplace MR, Weinberg GL, Neal JM, Barrington MJ. Local anesthetic systemic toxicity: a narrative literature review and clinical update on prevention, diagnosis, and management. Plast Reconstr Surg. 2019;144(3):783–95 A Review article on the recent trends and evidences on presentation and management of local anesthetic systemic toxicity.

    CAS  PubMed  Google Scholar 

  35. Waldinger R, Weinberg G, Gitman M. Local anesthetic toxicity in the geriatric population. Drugs Aging. 2019.

  36. Wong GK, Joo DT, McDonnell C. Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter. Anaesthesia. 2010;65(2):192–5.

    CAS  PubMed  Google Scholar 

  37. Wong GK, Crawford MW. Carnitine deficiency increases susceptibility to bupivacaine-induced cardiotoxicity in rats. Anesthesiology 2011;114(6):1417–24.

    CAS  PubMed  Google Scholar 

  38. Bern S, Weinberg G. Local anesthetic toxicity and lipid resuscitation in pregnancy. Curr Opin Anaesthesiol. 2011;24(3):262–7.

    PubMed  Google Scholar 

  39. Tsui BCH, Rosenquist RW. Clinical anesthesia. In: Barash PG, Cahalan MK, Cullen BF, Holtschoppen NA, Ortega R, Sharar SR, Stock MC, Stoelting RK, Holt NF, editors. Clinical anesthesia. 8th ed. Philadelphia: Wolters & Kluwer; 2017.

    Google Scholar 

  40. Vasques F, Behr AU, Weinberg G, Ori C, Gregorio GD. A review of local anesthetic systemic toxicity cases since publication of the American Society of Regional Anesthesia Recommendations: to whom it may concern. Reg Anesth Pain Med. 2015;40(6):698–705.

    CAS  PubMed  Google Scholar 

  41. Rice D, Heil JW, Biernat L. Pharmacokinetic profile and tolerability of liposomal bupivacaine following a repeated dose via local subcutaneous infiltration in healthy volunteers. Clin Drug Investig. 2017;37(3):249–57.

    CAS  PubMed  Google Scholar 

  42. Joshi GP, Patou G, Kharitonov V. The safety of liposome bupivacaine following various routes of administration in animals. J Pain Res. 2015;8:781–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Burbridge M, Jaffe RA. Exparel®: a new local anesthetic with special safety concerns. Anesth Analg. 2015;121(4):1113–4.

    PubMed  Google Scholar 

  44. Aggarwal N. Local anesthetics systemic toxicity association with exparel (bupivacaine liposome)- a pharmacovigilance evaluation. Expert Opin Drug Saf. 2018;17(6):581–7.

    CAS  PubMed  Google Scholar 

  45. Tran BW, Liebman ST, Reichman TW, Scott MJ. Hemodynamic instability and lipid emulsion resuscitation after subcutaneous injection of a liposomal bupivacaine admixture: a case report. AA Pract. 2019;12(7):223–5.

    Google Scholar 

  46. Brydone AS, Souvatzoglou R, Abbas M, Watson DG, McDonald DA, Gill AM. Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. Anaesthesia. 2015;70(7):784–90.

    CAS  PubMed  Google Scholar 

  47. Affas F. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety. Scand J Pain. 2016;13(1):59–66.

    PubMed  Google Scholar 

  48. Fenten MGE, Bakker SMK, Touw DJ, van den Bemt BJF, Scheffer GJ, Heesterbeek PJC, et al. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty. Acta Anaesthesiol Scand. 2017;61(3):338–45.

    CAS  PubMed  Google Scholar 

  49. Fenten MGE, Rohrbach A, Wymenga AB, Stienstra R. Systemic local anesthetic toxicity after local infiltration analgesia following a polyethylene tibial insert exchange: a case report. Reg Anesth Pain Med. 2014;39(3):264–5.

    PubMed  Google Scholar 

  50. Weibel S, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis† †This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 7. Br J Anaesth. 2016;116(6):770–83.

    CAS  PubMed  Google Scholar 

  51. Klein JA, Jeske DR. Estimated maximal safe dosages of tumescent lidocaine. Anesth Analg. 2016;122(5):1350–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Weinberg G. Local anesthetic systemic toxicity and liposuction: looking back. Looking Forward Anesth Analg. 2016;122(5):1250.

    PubMed  Google Scholar 

  53. Larson A, Stidham T, Banerji S, Kaufman J. Seizures and Methemoglobinemia in an Infant After Excessive EMLA Application. Pediatr Emerg Care. 2013;29(3):377–9.

    PubMed  Google Scholar 

  54. Kargl S, Hornath F, Rossegg U, Biebl A, Pumberger W, Schmitt K, et al. Status epilepticus, cardiac resuscitation, and posterior reversible encephalopathy syndrome after ingestion of viscous lidocaine: a plea for more childproof packaging of pharmaceuticals. Pediatr Emerg Care. 2014;30(3):185–7.

    PubMed  Google Scholar 

  55. Gaïes E, Jebabli N, Lakhal M, Klouz A, Salouage I, Trabelsi S. Delayed convulsion after lidocaine instillation for bronchoscopy. Rev Mal Respir. 2016;33(5):388–90.

    PubMed  Google Scholar 

  56. Nicholas E, Thornton MD. Lidocaine toxicity during attempted epistaxis cautery. J Emerg Med. 2016;51(3):303–4.

    PubMed  Google Scholar 

  57. Orebaugh SL, Kentor ML, Williams BA. Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database. Reg Anesth Pain Med. 2012;37(6):577–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. • Melnyk V, Ibinson JW, Kentor ML, Orebaugh SL. Updated retrospective single-center comparative analysis of peripheral nerve block complications using landmark peripheral nerve stimulation versus ultrasound guidance as a primary means of nerve localization. J Ultrasound Med. 2018;37(11):2477–88 This study analyzes ultrasound guidance for nerve blocks, for safety and prevention of complications like LAST and nerve injury.

    PubMed  Google Scholar 

  59. Mochizuki T, Sato S. Hypocapnia prolongs bradycardia induced by bupivacaine or levobupivacaine in isolated rat hearts. Can J Anesth. 2008;55(12):836–46.

    PubMed  Google Scholar 

  60. Wang Q-G, Wu C, Xia Y, Dong J-J, Lin T-T, Liu Q-Y, et al. Epinephrine deteriorates pulmonary gas exchange in a rat model of bupivacaine-induced Cardiotoxicity: a threshold dose of epinephrine. Reg Anesth Pain Med. 2017;42(3):342–50.

    CAS  PubMed  Google Scholar 

  61. Hiller DB, Gregorio GD, Ripper R, Kelly K, Massad M, Edelman L, et al. Epinephrine impairs lipid resuscitation from bupivacaine overdoseA threshold effect. Anesthesiology 2009;111(3):498–505.

    CAS  PubMed  Google Scholar 

  62. Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998;88(4):1071–5.

    CAS  PubMed  Google Scholar 

  63. Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105(1):217–8.

    PubMed  Google Scholar 

  64. Dun-Chi Lin J, Sivanesan E, Horlocker TT, Missair A. Two for one: a case report of intravenous lipid emulsion to treat local anesthetic systemic toxicity in term pregnancy. Case Rep. 2017;8(9):235–7.

    Google Scholar 

  65. Spence AG. Lipid reversal of central nervous system symptoms of bupivacaine toxicity. Anesthesiology 2007;107(3):516–7.

    PubMed  Google Scholar 

  66. Cave DG, Harrop-Griffiths DW, Harvey DM, Meek DT, Picard DJ, Short DT, et al. Management of severe local anaesthetic toxicity. The Association of Anaesthetists of Great Britain and Ireland; 2010.

  67. •• Neal JM, Woodward CM, Harrison TK. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 version. Reg Anesth Pain Med. 2018;43(2):150–3 It is the most recent and updated checklist from ASRA for management of LAST. It is designed for easy electronic downloading and has a smartphone app version as well.

    PubMed  Google Scholar 

  68. de Queiroz SM, Chassard D, Musard H, Heilporn A, Cejka J-C, Leveneur O, et al. Resuscitation with lipid, epinephrine, or both in levobupivacaine-induced cardiac toxicity in newborn piglets. Br J Anaesth. 2014;112(4):729–34.

    Google Scholar 

  69. Liu L, Xia Y, Chen Y, Wang Q, Shi T, Wang F, et al. The comparative effects of lipid, epinephrine and their combination in the reversal of bupivacaine-induced asystole in the isolated rat heart. Anesth Analg. 2012;114(4):886–93.

    CAS  PubMed  Google Scholar 

  70. •• Fettiplace MR, Weinberg G. The mechanisms underlying lipid resuscitation therapy. Reg Anesth Amp Pain Med. 2018;43(2):138 This article reviews the multiple mechanisms of action of lipids in local anesthetic toxicity, the evidences and the progress that has been made in understanding those mechanisms in treatment of LAST.

    Google Scholar 

  71. Fettiplace MR, Ripper R, Lis K, Lin B, Lang J, Zider B, et al. Rapid cardiotonic effects of lipid emulsion infusion*. Crit Care Med. 2013;41(8):e156–62.

    PubMed  Google Scholar 

  72. Fettiplace MR, Akpa BS, Ripper R, Zider B, Lang J, Rubinstein I, et al. Resuscitation with lipid emulsiondose-dependent recovery from cardiac pharmacotoxicity requires a cardiotonic effect. Anesthesiology 2014;120(4):915–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  73. Shin I-W, Hah Y-S, Kim C, Park J, Shin H, Park K-E, et al. Systemic blockage of nitric oxide synthase by L-NAME increases left ventricular systolic pressure, which is not augmented further by intralipid. Int J Biol Sci. 2014;10(4):367–76.

    PubMed  PubMed Central  Google Scholar 

  74. Van de Velde M, Wouters PF, Rolf N, Van Aken H, Flameng W, Vandermeersch E. Long-chain triglycerides improve recovery from myocardial stunning in conscious dogs. Cardiovasc Res. 1996;32(6):1008–15.

    PubMed  Google Scholar 

  75. Van de Velde M, DeWolff M, Leather HA, Wouters PF. Effects of lipids on the functional and metabolic recovery from global myocardial stunning in isolated rabbit hearts. Cardiovasc Res. 2000;48(1):129–37.

    PubMed  Google Scholar 

  76. Luo M, Yun X, Chen C, Bao N, Feng X, Pan L, et al. Giving priority to lipid administration can reduce lung injury caused by epinephrine in bupivacaine-induced cardiac depression. Reg Anesth Pain Med. 2016;41(4):469–76.

    CAS  PubMed  Google Scholar 

  77. Ozcan MS, Weinberg G. Intravenous lipid emulsion for the treatment of drug toxicity. J Intensive Care Med. 2014;29(2):59–70.

    PubMed  Google Scholar 

  78. Cao D, Heard K, Foran M, Koyfman A. Intravenous lipid emulsion in the emergency department: a systematic review of recent literature. J Emerg Med. 2015;48(3):387–97.

    PubMed  Google Scholar 

  79. Hayes BD, Gosselin S, Calello DP, Nacca N, Rollins CJ, Abourbih D, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol. 2016;54(5):365–404.

    CAS  Google Scholar 

  80. Brull SJ. Lipid emulsion for the treatment of local anesthetic toxicity: patient safety implications. Anesth Analg. 2008;106(5):1337–9.

    PubMed  Google Scholar 

  81. Levine M, Skolnik AB, Ruha A-M, Bosak A, Menke N, Pizon AF. Complications following antidotal use of intravenous lipid emulsion therapy. J Med Toxicol. 2014;10(1):10–4.

    CAS  PubMed  Google Scholar 

  82. Grunbaum AM, Gilfix BM, Hoffman RS, Lavergne V, Morris M, Miller-Nesbitt A, et al. Review of the effect of intravenous lipid emulsion on laboratory analyses. Clin Toxicol. 2016;54(2):92–102.

    CAS  Google Scholar 

  83. Sehgal LR, Sehgal HL, Rosen AL, Gould SA, Moss GS. Effect of intralipid on measurements of total hemoglobin and oxyhemoglobin in whole blood. Crit Care Med. 1984;12(10):907–9.

    CAS  PubMed  Google Scholar 

  84. Jeong J. Continuous renal replacement therapy circuit failures after antidote administration. Clin Toxicol. 2014;52(10):1296–7.

    Google Scholar 

  85. Lee HMD, Archer JRH, Dargan PI, Wood DM. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol. 2015;53(3):145–50.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Woodland Anesthesiology Associates, St. Francis Hospital, Hartford, CT, University of Connecticut School of Medicine, Farmington, CT, USA

    Sivasenthil Arumugam & Vanja Contino

  2. Department of Anesthesiology and Acute Pain Management, Cleveland Clinic, Cleveland, OH, USA

    Sree Kolli

Authors
  1. Sivasenthil Arumugam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vanja Contino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sree Kolli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sivasenthil Arumugam.

Ethics declarations

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Regional Anesthesia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arumugam, S., Contino, V. & Kolli, S. Local Anesthetic Systemic Toxicity (LAST) – a Review and Update. Curr Anesthesiol Rep 10, 218–226 (2020). https://doi.org/10.1007/s40140-020-00381-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-020-00381-x

Keywords

Search

Navigation