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Safer local anaesthetic practices through multidisciplinary engagement: A pre-post intervention study
Cansu Ozdemir1, Aksh Tailor1, Chimba Mubanga1
1School of Medicine, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Journal of Perioperative Practice
|June 17, 2026
Summary
Implementing standardized documentation, ideal body weight-based dosing, and structured communication significantly improved local anesthetic safety. These quality improvement measures reduced dosing errors and enhanced patient safety in perioperative care.
Area of Science:
- Anesthesiology
- Patient Safety
- Quality Improvement
Background:
- A fatal local anesthetic overdose in 2022 revealed critical safety deficits.
- Inconsistent documentation, variable dosing, and poor communication were identified issues.
Purpose of the Study:
- To enhance local anesthetic safety through standardized documentation.
- To implement ideal body weight-based dosing protocols.
- To improve multidisciplinary communication regarding anesthetic use.
Main Methods:
- A pre-post intervention study was conducted at a district general hospital.
- Interventions included standardized documentation, mandatory ideal body weight-based dose calculation, and surgeon-led vial checks.
- Data were collected via questionnaires from Operating Department Practitioners.
Main Results:
- Local anesthetic documentation increased from 68% to 91%.
- Ideal body weight-based dosing use rose from 29% to 94%.
- Preoperative brief discussions improved from 82% to 100%, with a reduction in overdoses.
Conclusions:
- Multidisciplinary interventions substantially improved local anesthetic safety.
- Standardized documentation, communication, and dosing are effective safety measures.
- Simple, scalable interventions can reduce errors and enhance perioperative safety.
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01:12Local Anesthetics: Adverse Effects
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
01:13Local Anesthetics: Pharmacokinetics
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:23Local Anesthetics: Mechanism of Action
Local anesthetics (LAs) block sensory and motor impulses by inhibiting the sodium channels on the nerve cell membranes. This induces temporary loss of sensation, relieving pain in a specific body area.
Local anesthetics are amphiphilic molecules consisting of a hydrophobic aromatic part linked to a hydrophilic group by an ester or amide linkage. They are weak bases and are usually available as salts, which increases their solubility and stability. Once administered, LAs exist in the body either...
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