Knowledge of Local Anesthetic Systemic Toxicity among Emergency Medicine Physicians: A Cross-Sectional Study

Background: Local anesthetics (LAs) are widely used in medical practice. The prevalence of LAs used has attracted attention with increasing reports of toxicity. To our knowledge, there is no study that surveyed emergency medicine physicians (EMPs) about local anesthetic systemic toxicity (LAST). We aimed to assess EMPs’ knowledge and awareness of LAST. Methods: This was a cross-sectional questionnaire-based study. EMPs working in the emergency department of a variety of hospitals (university, training and research, public, private) in Turkey participated in the study via e-mail. EMPs who did not use LAs and residents were excluded. The questionnaire was sent to physicians via e-mail, and responses were analyzed. Results: A total of 178 EMPs participated in the study and 20.8% and 22.5% of respondents recognized all the symptoms and treatment options of LAST respectively. About 4% had no knowledge on intravenous lipid emulsion (ILE) treatment, 41.6% used ILE treatment, and 42.1% were correct in the treatment dose of ILE. A significant correlation was found between the type of hospital and related training and the correct response of the ILE dose. Participants working at a university hospital had significantly higher correct answers (58.3%) on the treatment dose of ILE, but the correlation was weak (r: 0.165). Conclusion: Although LAST might have high mortality and morbidity in emergency patients, the level of EMPs’ knowledge and awareness of LAST is poor. The current training about LAs should be increased and standardized. EMPs should be encouraged to use ILE if indicated.

Local anesthetics, Systemic toxicity, Emergency medicine physicians, Intravenous lipid emulsion

[1] Cave G, Harrop-Griffiths W, Harvey M, et al. AAGBI safety guideline: management of severe local anaesthetic toxicity. AAGBI. 2010.

[2] Neal JM, Barrington MJ, Fettiplace MR, 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;43:113-123.

[3] Safety Committee of Japanese Society of A. Practical guide for the management of systemic toxicity caused by local anesthetics. J Anesth. 2019;33:1-8.

[4] Dickerson DM, Apfelbaum JL. Local anesthetic systemic toxicity. Aesthetic surgery journal. 2014;34:1111-1119.

[5] Lee LA, Posner KL, Cheney FW,et al. Complications associated with eye blocks and peripheral nerve blocks: an American Society of Anesthesiologists closed claims analysis. Region Anesth Pain M. 2008;33:416-422.

[6] Karasu D, Yılmaz C, Özgünay ŞE, et al. Knowledge of the research assistants regarding local anaesthetics and toxicity. Turk J Anaesthesiol Reanim. 2016;44:201.

[7] Oksuz G, Urfalioglu A, Sekmen T, et al. Dentists knowledge of lipid treatment of local anaesthetic systemic toxicity. Niger J Clin Pract. 2018;21:327.

[8] Sagir A, Goyal R. An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents. J Anesth. 2015;29:299-302.

[9] Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The knowledge of eye physi-cians on local anesthetic toxicity and intravenous lipid treatment:Questionnaire study. Turk J Ophthalmol. 2017;47:320.

[10] Collins J. Correspondence: awareness of local anaesthetic toxicity issues among hospital staff. Anaesthesia. 2010;65:960-961.

[11] Burillo-Putze G, Munne P, Duenas A, et al. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med. 2003;10:101-104.

[12] Koylu R, Dundar ZD, Koylu O, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6:59-65.

[13] Annual report on the state of the drugs problem in Europe. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) L, November 2010. accessable on: https://www.emcdda.europa. eu/publications/annual-report/2010_en .

[14] Patel PB, Anderson HE, Keenly LD, et al. Informed consent documentation for lumbar puncture in the emergency department. West J Emerg Med. 2014;15:318-24.

[15] Shaker SH, Hosseini Kasnavieh SM, et al. A Survey of Current Practice of Informed Consent in Iranian Hospitals. Hosp Top. 2018;96:69-74.

[16] Gaeta T, Torres R, Kotamraju R, et al. The need for emergency medicine resident training in informed consent for procedures. Acad Emerg Med. 2007;14:785-789.