Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector3626810.17816/RA36268Research ArticleSystemic toxicity of local anesthetics in regional anesthesiaKoryachkinVictor A.vakoryachkin@mail.ruGeras’kovE. V-KazarinV. S-Lis’kovM. A-MokhannaM.-Mal’tseM. P-MalevichG. M-FSBI “P.P. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics” MHC of RF1509201593455021072020Copyright © 2015, Eco-Vector2015The article presents description of clinical case of lipid emulsion rescue during severe toxic reaction occurred in reply to accidental intravenous injection of local anesthetic solution. The article includes comprehensive data about epidemiology, clinical course and treatment of systemic toxicity of local anesthetics. It considers up-to-date understanding of mechanisms of antitoxic effect of lipid emulsion. The protocol of lipid emulsion rescue during systemic toxicity of local anesthetics is presented in the paper.systemic toxicity of local anestheticsregional anesthesialipid emulsionсистемная токсичность местных анестетиковрегионарная анестезияжировая эмульсия[Корячкин В.А. Нейроаксиальные блокады - Спб: Издательство: ЭЛБИ-Спб, 2013; 544 с.][Kenepp N.B., Gutsche B.B. Inadvertent intravascular injections during lumbar epidural anesthesia. Anesthesiology. 1981 Feb; 54(2): 172-173.][Brown D.L., Ransom D.M., Hall J.A., Leicht C.H., Schroeder D.R., Offord K.P. Regional anesthesia and local anestheticinduced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth. Analg. 1995 Aug; 81(2): 321-328.][Auroy Y., Narchi P., Messiah A., Litt L., Rouvier B., Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997 Sep; 87(3): 479-486.][Finucane B.T., editor. Complications of Regional Anesthesia. 2nd Edn. New York: Springer; 2007 p.][Корячкин В.А., Эмануэль В.Л., Страшнов В.И. Диагностика в анестезиологии и интенсивной терапии. Спецлит. СПб, 2011; 414 с.][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. Anesth. Pain Med. 2010 Mar-Apr; 35(2): 181-187.][Корячкин В.А., Страшнов В.И. Анестезия и интенсивная терапия. С.-Петерб. мед. изд-во. СПб, 2004; 465 с.][Neal J.M., Bernards C.M., Butterworth J. F. 4th, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg. Anesth. Pain Med. 2010 Mar-Apr; 35(2): 152-161.][Rosenblatt M.A., Abel M., Fischer G.W., Itzkovich C.J., Eisenkraft J. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006 Jul; 105(1): 217-218.][Litz R.J., Popp M., Stehr S.N., Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006 Aug; 61(8): 800-801.][Shah S., Gopalakrishnan S., Apuya J., Martin T. Use of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity. J Anesth. 2009; 23: 439-441.][Jamaty C., Bailey B., Larocque A., Notebaert E., Sanogo K., Chauny J. M. Lipid emulsions in the treatment of acute poisoning: A systematic review of human and animal studies. Clin Toxicol (Phila). 2010; 48: 1-27.][West P.L., McKeown N.J., Hendrickson R.G. Iatrogenic lipid emulsion overdose in a case of amlodipine poisoning. Clin Toxicol (Phila). 2010; 48: 393-396.][Weinberg G.L., Ripper R., Murphy P., Edelman L.B., Hoffman W., Strichartz G., Feinstein D.L. Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart. Reg Anesth Pain Med. 2006; 31: 296-303.][Rahman S., Li J., Bopassa J.C., Umar S., Iorga A. et al. Phosphorylation of GSK-3 mediates intralipid induced cardioprotection against ischemia/reperfusion injury. Anesthesiology. 2011; 115: 242-253.][Weinberg G.L. Lipid emulsion infusion: resuscitation for local anesthetic and other drug overdose. Anesthesiology. 2012 Jul; 117(1): 180-187.][Ruan W., French D., Wong A., Drasner K., Wu A.H. A mixed (long- and medium-chain) triglyceride lipid emulsion extracts local anesthetic from human serum in vitro more effectively than a long-chain emulsion. Anesthesiology. 2012 Feb; 116(2): 334-339.][Auroy Y., Benhamou D., Bargues L., Ecoffey C. et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov; 97(5): 1274-1280.][Marwick P.C., Levin A.I., Coetzee A.R. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg. 2009; 108: 1344-1346.][McCutchen T., Gerancher J.C. Early intralipid therapy may have prevented bupivacaine-associated cardiac arrest. Reg Anesth Pain Med. 2008; 33: 178-180.][Mottram A.R., Valdivia C.R., Makielski J.C. Fatty acids antagonizebupivacaine-induced I(Na) blockade. Clinicaltoxicology. 2011; 49: 729-733.][Partownavid P., Umar S., Li J., Rahman S., Eghbali M. Fatty-acid oxidation and calcium homeostasis are involved in the rescue of bupivacaine-induced cardiotoxicity by lipid emulsion in rats. Crit Care Med. 2012 Aug; 40(8): 2431-2437.][Weinberg G.L., VadeBoncouer T., Ramaraju G.A., Garcia-Amaro M.F., Cwik M.J. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr; 88(4): 1071-1075.]