Dickinson Diana B, Beringer Craig, Moodley Pravani
Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Coll Med S Afr. 2024 Oct 16;2(1):85. doi: 10.4102/jcmsa.v2i1.85. eCollection 2024.
Local anaesthesia (LA) is frequently used in the Emergency Department (ED). Local anaesthetic systemic toxicity (LAST) is a potentially fatal complication associated with its use. It is assumed that all doctors administering LA are trained in all aspects of its use including the management of LAST.
A prospective, multicentre cross-sectional study was conducted at three academic EDs in Gauteng. Doctors working in the ED completed an online questionnaire designed to assess knowledge, attitudes and practices regarding the use of LA as well as the recognition and management of LAST.
A total of 94 completed questionnaires were analysed. Of these, 44% of participants had graduated from medical school less than 5 years ago, and 72% had less than 5 years of experience working in the ED. The overall mean knowledge score percentage for the safe use of LA was 48.2%. The overall mean knowledge score percentage for recognition and management of LAST was 56.7%. A total of 78% of participants knew that intravenous intralipid emulsion (ILE) therapy is needed in managing LAST; however, only 25% of participants knew where to access ILE and only 33% knew how to use it.
The overall level of knowledge on LA and the management of LAST among doctors working in the ED is low. There is also an apparent lack of awareness of the potential for toxicity despite frequent use of LA. Although the occurrence of LAST is rare, our findings highlight an obligation for continuous education on local anaesthesia and the management of LAST.
The result of this research indicates a gap in training regarding the potential for toxicity of local anaesthesia, recognition of systemic toxicity, and the management thereof. These findings suggest the possibility of misdiagnosis and under reporting of LAST.
局部麻醉（LA）在急诊科（ED）经常使用。局部麻醉药全身毒性反应（LAST）是与其使用相关的一种潜在致命并发症。假定所有实施局部麻醉的医生都接受过包括LAST处理在内的其使用各方面的培训。
在豪登省的三家学术性急诊科开展了一项前瞻性、多中心横断面研究。在急诊科工作的医生完成了一份在线问卷，该问卷旨在评估关于局部麻醉使用以及LAST识别与处理的知识、态度和实践。
共分析了94份完整问卷。其中，44%的参与者在5年前以内从医学院毕业，72%在急诊科工作不到5年。局部麻醉安全使用的总体平均知识得分百分比为48.2%。LAST识别与处理的总体平均知识得分百分比为56.7%。共有78%的参与者知道处理LAST需要静脉注射脂肪乳剂（ILE）治疗；然而，只有25%的参与者知道在哪里能获取ILE，只有33%的参与者知道如何使用它。
急诊科医生对局部麻醉及LAST处理的总体知识水平较低。尽管局部麻醉使用频繁，但对毒性可能性明显缺乏认识。虽然LAST的发生很罕见，但我们的研究结果凸显了持续开展局部麻醉及LAST处理教育的必要性。
本研究结果表明在局部麻醉毒性可能性、全身毒性识别及其处理方面的培训存在差距。这些研究结果提示存在LAST误诊和报告不足的可能性。
