The Role of Lipids in Local Anaesthetic Intoxication (Intralipids in Short Supply)

Systemic toxicity of local anaesthetics (LA) is a rare but often serious event. The clinical cases reported in the literature show that its clinical expression can be very polymorphous. The use of a peripheral block with ultrasound guidance reduces the incidence of vascular puncture and systemic toxicity Systemic toxicity is often delayed after L A injection. Therefore, close monitoring during the first 30 minutes after ALR (especially with ultrasound guidance) seems recommended. In case of a systemic accident, the administration of an intravenous lipid emulsion ELI is now part of the recommendations to be followed in case of cardiorespiratory arrest induced by a systemic overdose of local anaesthetic. The mechanisms of ELI are complex and probably multiple. Their use should therefore not replace other means of resuscitation, but appears to be an effective additional element. Further experimental studies and a clinical case registry will probably make it possible to better characterise the effects of an ELI-AL combination and to better understand the elements which, today, maintain the controversy of their use.