Local Anaesthesia Systemic Toxicity (LAST) – A Stroke Mimicker
Local Anesthesia Toxicity
Vol. 14 No. 1 : 2019 (266-269)
Abstract
Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
Keywords :
injection,
intra-articular,
lidocaine,
local anaesthesia,
shoulder joint,
stroke,
Correspondance Address
Tan Toh Leong. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 6482 Email: sebastianttl@yahoo.co.uk
References
Arcas-Bellas, J.J., Cassinello, F., Cercós, B., Del Valle, M., Leal, V., Álvarez-Rementería, R. 2009. Delayed quadriparesis after an interscalene brachial plexus block and general anesthesia: a differential diagnosis. Anesthesia & Analgesia 109(4): 1341-3.
Barrington, M.J., Kluger, R. 2013. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med 38(4): 289-99.
Chaturvedi, A., Dash, H.H. 2010. Locked-in syndrome during stellate ganglion block. Indian J Anaesth 54(4): 324-6.
Christie, L.E., Picard, J., Weinberg, G.L. 2014. Local anaesthetic systemic toxicity. BJA Education 15(3): 136-42.
Finucane, B.T., Tsui, B.C.H. 2007. Complications of brachial plexus anesthesia. In Complications of Regional Anesthesia. 2nd edition. Edited by Finucane BT. New York: Springer; 121-48.
Hayaran, N., Sardana, R., Nandinie, H., Jain, A. 2017. Unusual Presentation of Local Anesthetic Toxicity. J Clin Anesth 36: 36-8.
Smith, H.E., Rynning, R.E, Okafor, C., Zaslavsky, J., Tracy, J.I., Ratliff, J., Harrop, J., Albert, T., Hilibrand, A., Anderson, G., Sharan, A., Brown, Z., Vaccaro, A.R. 2007. Evaluation of neurologic deficit without apparent cause: the importance of a multidisciplinary approach. J Spinal Cord Med 30(5): 509-17.
Neal, J.M., Bernards, C.M., Butterworth, J.F. 4th, Di Gregorio, G., Drasner, K., Hejtmanek, M.R., Mulroy, M.F., Rosenquist, R.W. Weinberg, G.L. 2010. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med 35(2): 152-61.
Torp, K.D., Simon, L.V. Lidocaine Toxicity. [Updated 2018 Oct 27]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482479/ [21 June 2019].
