Anaes Cases · Acute pain & multimodal analgesia
The local anaesthetic systemic toxicity
The short case — the LAST. The stop the injection; the airway; the Intralipid 20 per cent (1.5 mL/kg + 0.25 mL/kg/min); the seizure control; the prolonged CPR if the cardiac arrest; the lipid-sink mechanism.
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ANZCAFRCAABAEDAIC
Prompt
After the TAP block with the ropivacaine, the patient reports the circumoral tingling and becomes agitated, then seizes. Manage.
Presentation
During the bilateral TAP block with the ropivacaine 0.5 per cent (the 20 mL each side, total 200 mg), the patient suddenly reports the circumoral tingling and the metallic taste, becomes agitated, and then has the generalised tonic-clonic seizure. Manage.
[1]References1ShowHide
- [1]Yuan FL, et al. Advances in Ultrasound-Guided Fascial Plane Blocks for Perioperative Acute Pain Management. J Invest Surg, 2026.PMID 42262005