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Multidisciplinary knowledge of local anaesthetic systemic toxicity in maternity care: A pilot study

02 February 2018
10 min read
Volume 26 · Issue 2

Abstract

Background

Although widely used in maternity care, the risks associated with local anaesthetic (LA) agents are commonly overlooked. The most serious avoidable risk associated with LA use is local anaesthetic systemic toxicity (LAST). Incidence in maternity settings is known to be underestimated due to under-recognition and under-reporting. LAST is a considerable problem, with potential financial and medico-legal as well as implications for patient safety.

Methods

A standardised, anonymised questionnaire was used to evaluate LAST awareness among staff of all disciplines. Awareness was examined across four domains: LA safe maximum doses, signs and symptoms of toxicity, immediate management, and the antidote type and location.

Findings

Poor LAST awareness was identified across all staff disciplines, with scope for substantial improvement with an interprofessional educational intervention. Only 17% were aware of any guidelines relating to LAST.

Conclusion

There is a need for greater focus on interdisciplinary education and the importance of shared responsibility in optimising patient safety.

Local anaesthetic (LA) agents are commonly used in all areas of healthcare, a fact that can be overlooked in maternity settings. The frequency of LA use in maternity care is significant, and includes epidural, spinal and pudendal nerve blocks, as well as subcutaneous infiltration before perineal tear repair. Care of patients using LA in maternity environments involves a particularly diverse multidisciplinary team, with a broad range of training backgrounds: midwives, maternity support workers (MSWs), anaesthetists (obstetric and general), obstetricians, junior doctors, and operating department practitioners, as well as midwifery and medical students, who may be involved in the care of a single woman to whom LA has been administered. It is therefore crucial that these agents and the risks associated with them are well understood by all groups.

Although LA is relatively safe (Skidmore et al, 1996), there are risks associated with its use, the most serious of which is local anaesthetic systemic toxicity (LAST). This is reported in up to 1 in 1000 peripheral blocks (van der Nest, 2012) and has resulted in maternal mortality and morbidity in the UK in recent years, although incidence is understood to be underestimated due to poor knowledge and recognition of LAST, and subsequent under-reporting (Collins, 2010). LAST represents a particular risk in the maternity setting, given the frequency of LA usage and the wide range of health professionals (and thus educational backgrounds) involved in patient care.

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