BODY ON BLOCK: CENTRAL NERVOUS SYSTEM TOXICITY STATUS POST SPINAL BLOCK

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

J Gen Intern Med

Abstract

CASE: 59-year-old woman with a history of fibromyalgia, rheumatoid arthritis, and bipolar disorder who was admitted for nausea and vomiting. 2 weeks prior she had a lidocaine injection in her cervical spine, and shortly after began experiencing confusion, double vision, and a feeling of restless. After calling the pain clinic, she was directed to the emergency department. While in the emergency department the patient endorsed tactile hallucinations, stating that there was hair on her tongue that she felt something on her face. When seen by Psychiatry, the patient had notable nystagmus, akathisia, and slurred speech. Per her outpatient psychiatric provider who has been seeing the patient for 4 years, the patient has not experienced hallucinations, even when suffering from significant depression. Also, the patient's psychiatric medications have remained stable for at least the past year. In considering the patient's past 2 weeks, the only major change is the administration of the cervical spinal block, most likely lidocaine injections. Her symptoms subsided without lipid emulsion. IMPACT/DISCUSSION: Impact: Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event associated with the increasingly prevalent utilization of local anesthetic (LA) techniques throughout various health care settings, with an incidence of 0.03%. LAST or surrogate outcomes include cardiac arrest, seizures, and use of lipid emulsion on the day of surgery. Early neurologic symptoms include tinnitus, oral numbness, metallic taste, and lightheadedness. One study found significant lapses in knowledge with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy. This lack of knowledge for providers administering the procedure increases the need for other medical providers to be aware of potential toxidromes from local anesthesia. Therefore, a case of toxicity following a cervical spinal procedure will be presented. Methods: We searched Pubmed, Scopus, and Web of Science using the keywords {(LA toxicity), (spinal block toxicity), (lidocaine or buprivocaine toxicity), (LA morbidity), (LA outcomes), (spinal block morbidity), (spinal block outcomes)} 182 articles were found with over 92 being animal studies Discussion: When considering the symptoms and their onset, there is a considerable concern for LAST. Central nervous system (CNS) side effects of lidocaine include dizziness, blurred vision, restlessness, slurred speech, ataxia, depression, nystagmus, hallucinations, and memory impairment. CNS symptoms usually precede cardiovascular symptoms, most commonly hypertension and tachycardia. Management is supportive or lipid emulsion if significant morbidity. CONCLUSION: By reviewing this case the goal is to address the knowledge gap for providers so that timely and optimal care can be provided to hopefully minimize serious morbidity and mortality.

Volume

37

First Page

S429

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