• D J Williams and J D Walker.
• Department of Anaesthetics, Abertawe Bro Morgannwg University NHS Trust, Morriston Hospital, Swansea, UK.
• Anaesthesia. 2014 Aug 1;69(8):847-53.

AbstractToxic dose limits (mg.kg(-1)) for local anaesthetics based on body weight are well-established, but calculation of the maximum safe volume (ml) of a given agent and formulation is complex, and frequently results in errors. We therefore developed a nomogram to perform this calculation. We compared the performance of the nomogram with a spreadsheet and a general purpose calculator using simulated clinical data. Bland-Altman analysis showed close agreement between the nomogram and spreadsheet, with bias of -0.07 ml and limits of agreement of -0.38 to +0.24 ml (correlation coefficient r(2) = 0.9980; p < 0.001). The nomogram produced fewer and smaller errors compared with the calculator. Our nomogram calculates the maximum safe volume (ml) of local anaesthetic to a clinically acceptable degree of accuracy. It facilitates rapid cross-checking of dosage calculations performed by electronic or other means at negligible cost, and can potentially reduce the incidence of local anaesthetic toxicity.© 2014 The Association of Anaesthetists of Great Britain and Ireland.

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