Toxicity of local anaesthetics

The complications of failure, neural injury and local anaesthetic toxicity are common to all regional anaesthetic techniques, and individual techniques are associated with specific complications. All potential candidates for regional anaesthesia should be thoroughly evaluated and informed of potential complications. Central neural blockades still account for more than 70% of regional anaesthesia procedures. Permanent neurological injury is 0•02–0•07%. Pain on injection and paraesthesias while performing regional anaesthesia are danger signals of potential injury and must not be ignored. The incidence of systemic toxicity to local anaesthetics has significantly decreased in the past 30 years, from 0•2 to 0•01%. Peripheral nerve blocks are associated with the highest incidence of systemic toxicity (7•5 per 10 000) and the lowest incidence of serious neural injury (1•9 per 10 000).