Local Anaesthetic Dosing and Toxicity Knowledge in Australian Emergency Departments: A Multicentre Cross-Sectional...

Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of local anaesthetic (LA) use. This study assessed knowledge of LA dosing, LAST recognition and management among emergency clinicians in Australia.

A multicentre cross-sectional survey was conducted at three emergency departments in Queensland, Australia. The survey assessed recall knowledge of recommended maximum local anaesthetic doses, recognition and management of LAST, and self-reported clinician confidence.

Of 114 participating clinicians, fewer than half correctly identified the recommended maximum dose for any of the four evaluated LA agents, including for their preferred agent for regional anaesthetic techniques. Correct responses ranged from 18.4% for bupivacaine to 48.2% for lidocaine. Cardiovascular manifestations of LAST were the most frequently recognised features; 21.9% of respondents could not recall any features of LAST. 57.9% of respondents identified lipid emulsion therapy as a management strategy; however, only 10.5% correctly stated a dosing regimen and 6.1% knew its location within their department. Knowledge of doses, LAST recognition and management all significantly improved with clinician seniority. Self-reported confidence was positively associated with knowledge of LAST recognition and management.

Emergency clinicians in this survey demonstrated substantial knowledge gaps in safe LA dosing, LAST recognition and aspects of management. These findings support a need for targeted education and system-level interventions to improve preparedness for this potentially life-threatening emergency.