Anaes · Local anaesthetic pharmacology

Local anaesthetic pharmacokinetics, dosing and maximum doses

Also known as Local anaesthetic maximum doses · Local anaesthetic systemic toxicity (LAST) · Lipid emulsion rescue · Mg per kg dose calculation

Local-anaesthetic dosing safety turns on weight-based calculation per local formulary with fractional-toxicity tracking (textbook framework). MaxSafe is a free open-source calculator with cartridge-based input, cumulative fractional toxicity and epinephrine tracking, validated exact across 23 scenarios; up to 87 percent of dental practitioners cannot correctly calculate doses with fatal pediatric overdoses reported (Christensen 2026). LAST is excessive absorption or intravascular injection causing seizures, arrhythmias and cardiovascular collapse with rapid identification, lipid emulsion, airway, seizure control and modified ACLS (Meral 2026). ESPB versus thoracic epidural showed similar analgesia for multiple rib fractures with earlier VTE prophylaxis supporting ESPB safety (Merchant 2026, n=324). Obese scoliosis patients with liposomal bupivacaine consumed less total MME per kg, hypothesis-generating for altered pharmacokinetics (Ogu 2026, n=190). Local-only anesthesia without an anesthesia professional follows AORN assessment, administration, postoperative, adverse-reaction and policy recommendations (Little 2026). Higher supraclavicular volume-dose accelerated onset and prolonged duration with volume-dependent ONSD increase (Copur 2026, n=64).