Local Anaesthetic Toxicity

LA toxicity is a rare complication resulting from high drug plasma levels. It is very unlikely to occur on labour ward with the doses we use. Your catheter may be intravenous.

Mild symptoms include tinnitus, visual disturbance and circumoral tingling. Moderate toxicity causes convulsions. In severe toxicity, cardiovascular collapse and/or respiratory failure may occur. Cardiovascular collapse due to bupivacaine (and to a lesser extent ropivacaine) may be impossible to treat.

Management of Local Anaesthetic Toxicity

Treatment is supportive. Hypoxia and acidosis exacerbate toxicity

Stop injecting or infusing local anaesthetic

Call for help early

Monitor the mother with ECG, frequent BP and oximetry

Monitor the fetus continuously

Use left lateral tilt

If the patient's conscious state is deteriorating, intubate and ventilate them.

Treat seizures with midazolam

In the unlikely event of cardiovascular or respiratory collapse use the normal ALS algorithm.

(Consider intra-lipid for bupivacaine or ropivacaine induced arrhythmias)