Radcliffe Kate G, Adler Tessa, Petersen Jordan, Howell Kaitlen, Nagdev Arun, Martin David
School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Emergency Medicine, Highland Hospital - Alameda Health System, Oakland, California, USA.
J Am Coll Emerg Physicians Open. 2025 Mar 20;6(3):100102. doi: 10.1016/j.acepjo.2025.100102. eCollection 2025 Jun.
Local anesthetic systemic toxicity (LAST) is a rare but serious complication of ultrasound-guided nerve and hematoma blocks, affecting the cardiovascular and central nervous systems. Clinicians performing these procedures should be aware of the possibility of LAST, recognize the early signs and symptoms, and understand the current accepted treatment. We present a case of cardiovascular collapse caused by LAST following an ultrasound-guided sternal hematoma block and discuss potential systems-based improvements to enhance the management and prevention of this life-threatening emergency. Thoracic blocks may pose a higher risk of LAST because of the close proximity to the heart, and we recommend using lower doses of local anesthetic when performing these blocks.
局部麻醉药全身毒性反应（LAST）是超声引导下神经阻滞和血肿阻滞罕见但严重的并发症，可影响心血管系统和中枢神经系统。实施这些操作的临床医生应意识到发生LAST的可能性，识别早期体征和症状，并了解当前公认的治疗方法。我们报告1例超声引导下胸骨血肿阻滞后发生LAST导致心血管虚脱的病例，并讨论基于系统的潜在改进措施，以加强对这种危及生命的紧急情况的管理和预防。由于与心脏距离较近，胸部阻滞可能具有更高的LAST风险，我们建议在实施这些阻滞时使用较低剂量的局部麻醉药。
