Safe use of local anaesthetics: prevention and management of systemic toxicity

Local anaesthetic administration is a common clinical practice not only in the operating theatres, but also in other clinical settings. Relevant monitoring and resuscitation facilities in certain clinical settings outside the operation rooms may not be optimal. Despite the low incidence of severe complications associated with administration of local anaesthetics, their safe use is very important since systemic toxicity can be fatal. This article reviews the pharmacology of local anaesthetics, clinical features of systemic toxicity resulting from their local use, and necessary preventive measures and management. The role of lipid emulsion therapy is also discussed.