Poisonings and deaths linked to using the native anesthetic lidocaine have almost tripled within the US over the previous decade, finds an evaluation of Nationwide Poison Information System (NPDS) stories, revealed on-line within the journal Regional Anesthesia & Ache Drugs.
This enhance contrasts with the general fall in reported poisonings and deaths from different kinds of native anesthetics over the identical interval, the evaluation exhibits.
Native anesthetics are extensively used for ache management, however carry an inherent danger of systemic toxicity, known as LAST, prompting a number of skilled societies to subject suggestions in 2010 to handle this.
The researchers wished to seek out out what impression these suggestions might need had by evaluating the durations 2001–10 and 2010–22. They due to this fact mined stories submitted to US poisons management facilities, the NPDS, from 1983 to 2022.
They assessed the annual variety of stories of poisoning and deaths from native anesthesia, grouped by lidocaine and non-lidocaine, from 2001 onwards, when stories on lidocaine had been first submitted individually. Additionally they appeared on the variety of stories of poisoning and deaths from all different substances.
They recorded particulars of particular person instances the place these had been out there: age; gender; kind of native anesthetic; supply methodology; supply web site (working room, dwelling, inpatient, outpatient, emergency division, emergency medical providers); dose; and different remedies to reverse poisoning.
Between 1983 and 2022, 74 deaths related to an area anesthetic had been reported out of a complete of 203,853 native anesthetic poisonings. This compares with a complete of 39,913 stories of loss of life out of 79,360,369 stories of poisoning from all causes.
Total, from 2001 to 2022, 0.1% of stories of lidocaine poisoning resulted in a report of loss of life, in contrast with 0.01% of stories of non-lidocaine poisoning.
From 2010 onwards, the relative danger of native anesthetic poisoning was 23% decrease than that of the previous decade. However this was primarily pushed by an annual 50% discount in stories of non-lidocaine poisoning from greater than 6,000 to fewer than 3,000.
Experiences of lidocaine poisoning, however, rose by greater than 50%, from 1,600 in 2016 to 2,500 in 2021.
And the relative danger of loss of life from an area anesthetic greater than doubled between 2011 and 2022 in contrast with the previous decade, pushed by a rise in stories of loss of life related to lidocaine.
Detailed evaluation of 59 particular person deaths from all kinds of poisoning revealed that 32 had been reported earlier than 2010 (common age of 25) and 27 had been reported between 2011 and 2022 (common age 55).
Among the many fatalities between 1983 and 2010, lidocaine had been utilized in two thirds of instances (67%), whereas it had been utilized in most (82%) deadly instances between 2011 and 2022.
Whereas there was an general fall in stories of working room deaths related to native anesthesia from 47% earlier than 2010 to fifteen% afterwards, prehospital deaths (emergency medical providers or emergency division) rose from 7% to 31%. And stories of loss of life from intravenous lidocaine elevated from 3% to 27% of the overall.
Virtually all instances of lidocaine deaths concerned doses that often exceeded the advisable higher restrict on the package deal insert, each earlier than and after 2010. These included doses of two,000 mg—500 mg is the advisable most dose—-administered by emergency medical providers and in emergency division settings, usually by mistake.
The researchers spotlight current case stories suggesting that even small doses of intravenous lidocaine could cause critical negative effects in at-risk sufferers.
To counter the cardiac and neurological results of lidocaine poisoning, lipid emulsion remedy is advisable, however evaluation of the person instances exhibits that this was inconsistently used. And in lots of instances, the affected person nonetheless died, suggesting it was administered too late. Nevertheless it is probably not sufficient by itself if the affected person has obtained a really massive dose of intravenous lidocaine, recommend the researchers.
The researchers acknowledge some limitations to their findings, together with the potential of under-reporting to the NPDS and incomplete medical data for all of the instances analyzed.
Additionally they recommend {that a} extra acceptable comparator might need been poisonings at well being care areas. Between 2001 and 2002, non-lidocaine stories equated to 85% of whole poisonings at well being care areas, however between 2021 and 2022, they amounted to 31%, suggesting that the discount in native anesthetic poisonings and deaths might need been underestimated.
“Our findings should be interpreted cautiously, as adjustments in reported poisonings and deaths might not replicate precise incidence because of the absence of population-level publicity information,” they emphasize.
“Nevertheless, these findings spotlight the necessity for enhanced administrative steering on lidocaine use, larger consciousness of the dangers of excessive doses of lidocaine, and improved methods for stopping and managing extreme lidocaine-induced toxicity,” they conclude.
Extra data:
The impression of native anesthetic systemic toxicity advisories on reporting to the Nationwide Poison Information System (NPDS), Regional Anesthesia & Ache Drugs (2025). DOI: 10.1136/rapm-2025-106464
Quotation:
Close to tripling in US reported lidocaine native anesthetic poisonings/deaths over previous decade, evaluation reveals (2025, July 21)
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