ABSTRACT
ABSTRACT: Local anesthetic systemic toxicity (LAST) is a life-threatening event caused by elevated local anesthetic plasma concentration. It is often unrecognized or misdiagnosed. Peripartum women are at increased risk for toxicity due to pregnancy-related physiological changes. Rising serum drug levels can cause cellular level impairment of mitochondria and voltage-gated ion channels leading to a cascade of symptoms that can end in cardiac arrest. Local anesthetic systemic toxicity can mimic other maternal pathologies but may be considered if local anesthetics have been used. Published treatment guidelines for this event include lipid emulsion which is approved for use in pregnant women. We review LAST in the maternity care setting, published treatment protocols, management of maternity patients with toxicity, and recommendations to increase awareness among maternity care clinicians for this medical emergency.
Subject(s)
Anesthesia, Local/adverse effects , Anesthetics, Local/adverse effects , Anesthetics, Local/toxicity , Drug-Related Side Effects and Adverse Reactions/diagnosis , Fat Emulsions, Intravenous/administration & dosage , Fat Emulsions, Intravenous/therapeutic use , Labor, Obstetric , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Maternal Health Services , Postpartum Period , Practice Guidelines as Topic , PregnancyABSTRACT
The purpose of this study was to compare the efficacy and safety of extended-release epidural morphine (EREM) and perineural infusion (PNI) to control pain after total knee arthroplasty. A convenience sample of 200 patients was obtained using a retrospective chart review of patients who underwent a total knee arthroplasty. Institutional review board approval was obtained, and 100 charts of patients who received EREM and 100 patient charts for PNI were reviewed. The main end points were pain scores up to 48 hours postoperatively, and the ancillary end points were supplemental opioid requirements and adverse effects. Data were analyzed using the Pearson chi2 where appropriate or the Fisher exact test, and all continuous variables were examined using a Wilcoxon rank test. The results of the study showed no significant differences between the 2 groups for the levels of pain preoperatively, immediately postoperatively, and at 48 hours postoperatively. However, at both 12 hours and 24 hours postoperatively, the PNI group had a significantly higher pain score than the EREM group. The EREM group had better pain scores; however, one must look at a number of different variables when deciding if EREM is the correct choice for postoperative pain management.