Systematic Review and Meta-Analysis of Lipid Emulsion for Non-Local Anesthetic Poisoning

Practitioners routinely use intravenous lipid emulsion for local anesthetic systemic toxicity, but its role in non-local anesthetic poisonings remains unclear. We conducted a systematic review and meta-analysis comparing lipid emulsion with standard care for non-local anesthetic toxicities.

We searched PubMed, Embase, Scopus and Web of Science from January 1st 2010 until March 16th 2026 for human randomized controlled trials evaluating lipid emulsion for non-local anesthetic poisoning. Volunteer studies and pediatric-only studies were excluded. The primary outcome was intensive care unit admission (with intubation as a surrogate for unit-level needs). Secondary outcomes included mortality, seizures, and hospital length of admission. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effect meta-analysis was conducted. Heterogeneity was analyzed using Cochran's Q and I².

Twelve studies with 816 patients were included, predominantly using 20% SMOFlipid® 280 - 500 mL. Lipid emulsion reduced intensive care unit admission compared to standard care (RR=0.70; 95% CI: [0.53, 0.93], 8 studies, n=369) with moderate heterogeneity (Q=9.43, p=0.02; I²=32.12%). Lipid emulsion also reduced mortality (RR=0.65; 95% CI: [0.53, 0.80]) and length of admission (Mean diff. =-34.16; 95% CI: [-42.29,-26.02]). Seizure incidence was lowered but not significantly (RR=0.27; 95% CI [0.06, 1.26]).

Intravenous lipid emulsion is associated with reduced intensive care unit admission and mortality for aluminum phosphide and organophosphate poisonings and a reduced length of admission for aluminum phosphide, organophosphate, and antipsychotic poisonings. The evidence is limited by study heterogeneity and study quality. Larger, high-quality trials are needed to confirm benefit.

CRD42025645519.