Sushma Athota S. Junior Resident, Department of Anesthesiology, Intensive care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Nazia Nazir Professor, Department of Anesthesiology, Intensive Care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Samiksha Khanuja Professor, Department of Anesthesiology, Intensive care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Ruchi Singh Assistant Professor, Department of Anesthesiology, Intensive care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Savita Gupta Associate Professor, Department of Anesthesiology, Intensive care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Anupriya Saxena Assistant Professor, Department of Anesthesiology, Intensive care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Address for correspondence: Nazia Nazir, Professor, Department of Anesthesiology, Intensive Care & Pain Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India E-mail: nazunazir@gmail.com
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Athota SS, Nazir N, et al. A case report on early-onset local anesthetic toxicity. Ind J Anesth Analg. 2025;12(1):57-60.
Timeline
Received : December 28, 2024
Accepted : January 29, 2025
Published : March 15, 2025
Abstract
Systemic toxicity of local anesthetics results from excessive plasma concentrations of these drugs, most often from accidental intravascular injection. Systemic reactions primarily involve the CNS and the cardiovascular system. In general, the CNS is more susceptible to the actions of systemic local anesthetics than the cardiovascular system is, and thus the dose or blood level of local anesthetic required to produce CNS toxicity is usually lower than that resulting in circulatory collapse[1]. Here we present the case of a 45-year-old male patient who had ultrasonography guided supra-clavicular brachial plexus block. The patient had an episode of seizure immediately (with-in 30 sec) after administering the local anesthetic (13 ml given in 5 ml aliquots injected after negative aspiration). He was treated with intravenous midazolam (2 mg stat) and supplemental oxygen via facemask. He had no neurological symptoms afterwards. All laboratory tests and radiological investigations were normal. This case report records the occurrence of local anesthetic toxicity observed as seizure activity, after ultrasound guided brachial plexus block due to accidental intravascular injection, as negative aspiration of the syringe does not always exclude intravascular placement.
References
1. Di Gregorio G., Neal J.M, Rosenquist R.W, Weinberg G.L. Clinical presentation of local anesthetic systemic toxicity: A review of published cases, 1979 to 2009. Reg AnesthPain Med. 2010;35:181–187.
2. El-Boghdadly K., Pawa A., Chin K.J. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018 Aug 8; 11:35-44.
3. Neal J.M., Bernards C.M., Butterworth JF 4th, Di Gregorio G., Drasner K., Hejtmanek MR, Mulroy M.F., Rosenquist R.W., Weinberg GL. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010 Mar-Apr; 35(2):152-61. doi: 10.1097/ AAP.0b013e3181d22fcd.
4. Groban L. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med. 2003 Jan-Feb; 28(1): 3-11. doi: 10.1053/rapm.2003.50014. 5. Weinberg G.L. Current concepts in resuscitation of patients with local anesthetic cardiac toxicity. Reg Anesth Pain Med. 2002 Nov-Dec; 27(6): 568-75. doi: 10.1053/rapm. 2002.37126.
6. Tuzen A.S., Arslan Yurtlu D., Cetinkaya A.S., Aksun M., Karahan N. A Case of Late-Onset Local Anesthetic Toxicity Observed as Seizure Activity. Cureus. 2022 Jun 4; 14(6): e25649. doi: 10.7759/cureus.25649.
7. Neal J.M., Neal E.J., Weinberg G.L. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med. 2021 Jan; 46(1): 81-82. doi: 10.1136/rapm-2020- 101986. Epub 2020 Nov 4.
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Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
we hereby state that there were no ethical issues involved.
Acknowledgements
Consent for publication has been obtained from the patient.
Conflicts of Interest
The authors report no conflicts of interest in this work.
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Cite this article
Athota SS, Nazir N, et al. A case report on early-onset local anesthetic toxicity. Ind J Anesth Analg. 2025;12(1):57-60.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.