Lipid emulsion: is there sufficient knowledge among hospital staff?

Assessment of Awareness of Local Anaesthetic Systemic Toxicity (LAST) among Postgraduate Trainees

INTRODUCTION

Although uncommon, local anaesthetic systemic toxicity (LAST) may impose fatal risk to the patients. We investigated the awareness of LAST and knowledge on local anaesthetics among our postgraduate trainees.

MATERIALS AND METHODS

A total of 134 postgraduate trainees from the departments of general surgery (Surgical), orthopaedic surgery (Ortho), otorhinolaryngology (ENT), obstetrics and gynaecology (OBGYN), as well as anaesthesiology and intensive care (Anaesth) were recruited. A validated questionnaire was used to assess awareness and knowledge. All participants attended a medical-education session and completed the questionnaire as preassessment and postassessment. Data were analysed, and comparisons between disciplines were conducted.

RESULTS

The trainees' awareness of LAST was overall poor at preassessment which improved almost 6-folds at postassessment. Surprisingly, only 20 (45.5%) participants from the anaesthesiology group had awareness of LAST at preassessment, and none of the participants were from surgical, orthopaedic, and obstetrics and gynaecology departments. Preassessment scores were significantly higher in the anaesth group as compared to all other groups; with a difference in the average score for Anaesth vs Surgical of 3.46 (95%, CI:2.17, 4.74), Anaesth vs Ortho of 3.64 (95%, CI:2.64, 4.64), Anaesth vs ENT of 3.43 (95%, CI:2.20, 4.67), and Anaesth vs OBGYN of 6.93 (95%, CI:5.64, 8.21). However, there was no significant difference of awareness scores between all participants at postassessment scores.

CONCLUSION

The overall level of awareness was poor. However, the implementation of an education session significantly improved the knowledge and awareness across all disciplines.

A survey on the use of intravenous lidocaine infusion for acute pain in Scottish Hospitals

Introduction

Intravenous (IV) lidocaine infusions are increasingly used in the management of acute pain. They are particularly used in patients undergoing colorectal surgery, where they are also found to decrease rates of postoperative ileus. IV lidocaine has significant toxicity in overdose. There are no current national guidelines or standards on the provision of IV lidocaine infusions. We aimed to get a snapshot of current usage and usage practices in Scottish NHS Hospitals, to identify common themes and variations in practice.

Methods

A survey designed by the authors was emailed to 20 Scottish NHS Hospitals with an acute pain team. These were then followed up by telephone, if necessary.

Results

Of the 20 hospitals, 16 (80%) responded; 12 out of 16 (75%) of the responding hospitals either used IV lidocaine infusions for acute pain or were planning to use them in the near future. There was variability in practices regarding delivery device, prescriber grade, bolus dosing, length of infusion, location of infusion and use with other local anaesthetic (LA) infusions.

Conclusions

A majority of Scottish NHS Hospitals use IV lidocaine infusions in the management of acute pain. There are some variations in current practice; standardising practices may decrease the risk of LA toxicity. A national guideline is recommended.