An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka.

Abstract

Background: Inadvertent over-dosage or intravascular injections may still lead to systemic toxicity. Local anesthetic systemic toxicity (LAST) could be potentially life threatening. This study focused on the current knowledge and practices in use of LA by the doctors in Sri Lanka and their ability to detect and manage an event of LAST. Methodology: A descriptive cross-sectional study was conducted among doctors in Sri Lanka using an online self-administered questionnaire based on AAGBI guidelines (2010). Descriptive statistics were analyzed by cross-tabulations and presented as numbers and percentages using IBM-SPSS 25. Results: The response rate was 60% out of 600 doctors. Majority were males (58%) while 45% of the respondents were anesthetists. Ultrasound was used by 47.4% during specific LA use. The majority (74%) considered total body weight for dose calculations. Around 50% of the respondents identified bupivacaine as the most cardiotoxic. The majority (77%) utilized some form of monitoring and were knowledgeable on identification, prevention and initial management of LAST. Approximately 45% identified Intralipid (ILE) as the definitive treatment of LAST, out of which, 66.8% knew the correct dose, 77.2% and 26.5%, the availability and the location of the stored drug, respectively. Conclusion: The basic knowledge about LAST was satisfactory among the respondents. A statistically significant difference on knowledge on maximum safe doses of LA, ILE in established LAST, its dosage and the availability was identified between anesthetists and non-anesthesia doctors; and postgraduate trainees and the rest of the doctors. Overall, significant lapses were noted with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy and ILE. © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.