A pre-hospital team administers a FICB with 40 mL of 0.25% levobupivacaine. Five minutes later, the patient develops perioral tingling, tinnitus, and ...

Question

A pre-hospital team administers a FICB with 40 mL of 0.25% levobupivacaine. Five minutes later, the patient develops perioral tingling, tinnitus, and visual disturbance followed by a generalised tonic-clonic seizure. What is the diagnosis and what is the specific treatment?

Accepted Answer

Local anaesthetic systemic toxicity (LAST) - administer IV 20% Intralipid (lipid emulsion therapy) and benzodiazepines for the seizure

Answer

Epileptic seizure unrelated to the procedure - administer buccal midazolam only

Answer

Stroke - perform FAST assessment

Answer

Anaphylaxis to levobupivacaine - administer IM adrenaline 500 micrograms

Answer

Vasovagal syncope with myoclonus - elevate legs

uk-dipimc MCQ (SBA): Local Anaesthetic Toxicity

A pre-hospital team administers a FICB with 40 mL of 0.25% levobupivacaine. Five minutes later, the patient develops perioral tingling, tinnitus, and visual disturbance followed by a generalised tonic-clonic seizure. What is the diagnosis and what is the specific treatment?