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Reg Anesth Pain Med · Jul 2013
Multicenter Study Comparative StudyUltrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade.
The use of ultrasound for peripheral nerve blockade reduces the incidence of systemic local anesthetic toxicity by at least 65%, possibly 80%.
pearl- Michael J Barrington and Roman Kluger.
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia. michael.barrington@svhm.org.au
- Reg Anesth Pain Med. 2013 Jul 1; 38 (4): 289-99.
Background And ObjectivesLocal anesthetic systemic toxicity (LAST) is a potentially life-threatening complication of local anesthetic administration. In this article, the results of the Australian and New Zealand Registry of Regional Anaesthesia were analyzed to determine if ultrasound-guided peripheral nerve blockade (PNB) was associated with a reduced risk of LAST compared with techniques not utilizing ultrasound technology.MethodsThe period of study for this multicenter study involving 20 hospitals was from January 2007 through May 2012. The primary outcome was LAST comprising minor, major, and cardiac arrest (due to toxicity) events determined using standardized definitions. Multivariable logistic regression models and propensity score analyses were used to determine significant event predictors.ResultsThe study population comprised 20,021 patients who received 25,336 PNBs. There were 22 episodes of LAST, resulting in an incidence of LAST of 0.87 per 1000 PNBs (95% confidence interval, 0.54-1.3 per 1000). Ultrasound guidance was associated with a reduced incidence of local anesthetic toxicity. Site of injection, local anesthetic type, dose per weight, dose, and patient weight were all predictors of LAST.ConclusionsThis study provides the strongest evidence, to date, that ultrasound guidance may improve safety because it is associated with a reduced risk of LAST following PNB.
This article appears in the collections: Regional stuff and Meta-analyses.
Notes
The incidence of systemic local anesthetic toxicity showed different risk profiles at different injection sites. In order of decreasing incidence of systemic toxicity events:
- Paravertebral – OR 3.62 [95% CI, 1.33–7.86]
- Upper limb — OR 1.75 [95% CI, 0.93–2.99]
- Lower limb — OR 0.24 [95% CI, 0.05–0.71]
- Trunk — 0.00 [95% CI, 0–0.94]
Of the 25,336 peripheral nerve blocks in the study, there were only 22 episodes of local anesthetic toxicity. 12 events occurred in the 20,401 PNBs performed with ultrasound guidance and 10 events in the 4,745 blocks performed without ultrasound.
Daniel Jolley
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