Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of anaesthesia. Patterns presentation have evolved over recent years due part increasing ultrasound which has been demonstrated reduce risk. Onset is increasingly delayed, a greater proportion reports are secondary fascial plane blocks, and cases where non-anaesthetist providers involved. The evolving context presents challenge for diagnosis requires education all physicians, nurses allied health professionals about these changing patterns risks. This review discusses: mechanisms; prevention; diagnosis; treatment toxicity. dose used, site injection block conduct technique important determinants toxicity, as various patient factors. Risk mitigation discussed including care at-risk groups, such as: those at extremes age; patients cardiac, hepatic specific metabolic diseases; who pregnant. Advances landscape novel applications settings anaesthesia also described. Finally, we signpost future directions potentially improve management utility anaesthetics remains unquestionable thus maximising safe appropriate drugs should translate improvements care.