From the *Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College New York, NY; †Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria; and ‡Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Reg Anesth Pain Med. 2017 Jul/Aug;42(4):442-445. doi: 10.1097/AAP.0000000000000544.
Peripheral nerve blocks are increasingly used. However, despite low complication rates, concerns regarding local anesthetic systemic toxicity remain. Although recent studies suggest that this severe complication has decreased considerably, there is a paucity of data about it on a national level. We sought to elucidate the incidence of local anesthetic systemic toxicity on a national level and therefore provide guidance toward the need for preparedness in daily anesthetic practice.
We searched a large administrative database for patients who received peripheral nerve blocks for total joint arthroplasties from 2006 to 2014. Their discharge and billing data were analyzed for International Classification of Diseases, Ninth Revision, Clinical Modification codes coding for local anesthetic systemic toxicity or surrogate outcomes including cardiac arrest, seizures, and use of lipid emulsion on the day of surgery. Rates for these outcomes were determined cumulatively and over time.
We identified 238,473 patients who received a peripheral nerve block within the study period. The cumulative rate of outcomes among these patients in the study period was 0.18%. There was a significant decrease of overall outcome rates between 2006 and 2014. Use of lipid emulsion on the day of surgery increased significantly in total knee replacement from 0.02% 2006 to 0.26% in 2014.
The incidence of local anesthetic systemic toxicity is low but should be considered clinically significant. Since it may cause substantial harm to the patient, appropriate resources and awareness to identify and treat local anesthetic systemic toxicity should be available wherever regional anesthesia is performed.
外周神经阻滞的应用日益广泛。然而，尽管并发症发生率较低，但人们仍对局部麻醉药全身毒性的问题感到担忧。尽管最近的研究表明，这种严重并发症已显著减少，但在全国范围内，关于其的数据仍很匮乏。我们旨在阐明全国范围内局部麻醉药全身毒性的发生率，从而为日常麻醉实践中做好应对准备提供指导。
我们在一个大型行政数据库中检索了 2006 年至 2014 年间接受外周神经阻滞行全关节置换术的患者。分析其出院和计费数据中是否存在国际疾病分类第 9 版临床修订版编码为局部麻醉药全身毒性或替代结局（包括手术当天的心脏骤停、癫痫发作和使用脂肪乳）的代码。确定这些结局的累积发生率和随时间的变化。
我们确定了 238473 名在研究期间接受外周神经阻滞的患者。这些患者在研究期间的结局累积发生率为 0.18%。2006 年至 2014 年，总体结局发生率呈显著下降趋势。在全膝关节置换术中，手术当天使用脂肪乳的比例从 2006 年的 0.02%显著增加至 2014 年的 0.26%。
局部麻醉药全身毒性的发生率较低，但应被视为具有临床意义。由于其可能对患者造成严重伤害，因此无论在何处实施区域麻醉，都应备有适当的资源和意识来识别和治疗局部麻醉药全身毒性。
