Anesthesia Alert: Lidocaine Toxicity and Regional Anesthesia: What You Need to Know

In the ambulatory surgery environment, regional anesthesia is a go-to technique for reducing postoperative pain. However, like any medical intervention, there can be risks. One such risk is lidocaine toxicity — a situation where too much of the local anesthetic enters the bloodstream.

Know the signs

Regional anesthesia is ideal for minimally invasive procedures. It involves numbing a specific area of the body to minimize pain. Lidocaine, a commonly used local anesthetic, is often the star player in regional anesthesia due to its fast-acting and effective numbing properties. But even a superstar can have its off days, and that’s when lidocaine toxicity can become an issue.

Knowing the signs and symptoms of lidocaine toxicity is a nurse’s superpower. Early detection can be a game-changer in ensuring prompt treatment. Signs of lidocaine toxicity from regional anesthesia may include:

• Nervousness or confusion
• Tingling or numbness around the mouth or extremities
• Dizziness or lightheadedness
• Changes in heart rate or rhythm
• Visual disturbances
• Seizures
• Unconsciousness

Managing lidocaine toxicity

When you suspect lidocaine toxicity, call for help, announce the possible crisis and do the following:

• Halt the lidocaine. Stop administering lidocaine immediately. You want to prevent more of it from entering the system.Keep a close eye on the patient’s blood pressure, heart rate, and breathing. Quick changes could indicate worsening toxicity.

• Check the heart. Since lidocaine can impact the heart’s rhythm, monitoring the electrocardiogram is crucial. Bring the crash cart to the bedside and be prepared to initiate emergency interventions.

• Supply oxygen. Maintain adequate oxygenation and be prepared to use advanced airway delivery methods as needed.

• Medications. Have the following medications available: midazolam; 0.5% bupivacaine; 1% lidocaine; 20% lipid emulsion; and those used in ACLS.

• Consult the experts. Always keep the anesthesia provider or physician in the loop. They can guide further treatment. In a full crisis, enlist the help of ACLS-trained and ancillary staff. Prepare the patient for transfer to a higher level of care.

Preventing lidocaine toxicity starts with accurate dosing based on patient factors. Also, be aware of patients who might be more sensitive to lidocaine, such as those with certain health conditions. Educate patients about potential side effects and encourage them to report any unusual sensations.

Being vigilant and prepared is the nurse’s way, which is especially important when it comes to lidocaine toxicity. By recognizing the signs early and following proper protocols, ASC nurses play a pivotal role in ensuring patient safety and optimal outcomes during regional anesthesia procedures. This knowledge equips nurses to confidently navigate the intricacies of regional anesthesia and provide the best possible care for their patients in the dynamic setting of ASCs. OSM