Local anesthetic systemic toxicity with liposomal bupivacaine: a case series and literature review.
Liu Zhang, Yanjun Lin, Yan Qiu
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Case in brief
Two cases of Local Anesthetic Systemic Toxicity (LAST) following liposomal bupivacaine administration are presented. The first case involved a 55-year-old male who experienced cardiac arrest and recurrent ventricular fibrillation after receiving the anesthetic during thoracoscopic lobectomy. He recovered after lipid emulsion treatment. The second case involved a 67-year-old male who developed agitation and neurological symptoms post-surgery, with rapid improvement following lipid emulsion infusion.
Diagnostic / clinical pearl
Clinicians should be aware of the potential for severe LAST associated with liposomal bupivacaine, particularly in highly vascular areas.
Why it matters
These cases underscore the importance of careful dosing and technique when administering local anesthetics to minimize the risk of systemic toxicity.