Association of Anaesthetist of Great Britain and Ireland. Management of Severe Local Anaesthetic Toxicity: AAGBI Guidelines. 2010. (accessed 23 January 2018)

Bird A, Wallis M, Chaboyer W. Registered nurses' and midwives' knowledge of epidural analgesia. Collegian. 2009; 16:(4)193-200

Collins J. Correspondence: Awareness of local anaesthetic toxicity issues among hospital staff. Anaesthesia. 2010; 65:(9)960-1

Crofts J, Ellis D, Draycott T, Winter C, Hunt L, Akande V. Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training. BJOG. 2007; 114:(12)1534-41

Davies MW, Harrison JC, Ryan TD. Current practice of epidural analgesia during normal labour. Anaesthesia. 1993; 48:(1)63-5

Jadon A. Complications of regional and general anaesthesia in obstetric practice. Indian J Anaesth. 2010; 54:(5)415-20

Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003; 58:(11)1114-8

Jensen-Gadegaard P, Skjønnemand M, Damgaard-Jensen J, Gottschau B. Limited knowledge of lipid rescue therapy in local anaesthetic systemic toxicity. Dan Med Bull. 2011; 58:(1)

Karasu D, Yilmaz C, Özgünay S, Dayioglu M, Baytar Ç, Kofali G. Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity. Turk J Anaesthesiol Reanim. 2016; 44:(4)201-5

Lai H, Tsai P, Fan Y, Huang C. Anaesthetic practice for Caesarean section and factors influencing anaesthesiologists' choice of anaesthesia: a population-based study. Acta Anaesthesiol Scand. 2014; 58:(7)843-50

Morgan P. Maternal death following epidural anaesthesia for caesarean section delivery in a patient with unsuspected sepsis. Can J Anaesth. 1995; 42:(4)330-4

Unlawfully killed: the mother given fatal epidural dose minutes after birth. 2008. (accessed 14 June 2017)

Neuhaus S, Neuhaus C, Fluhr H Why mothers die: Learning from the analysis of anaesthesia-related maternal deaths (1985-2013). Anaesthesist. 2016; 65:(4)281-94

Sagir A, Goyal R. An assessment of the awareness of local anaesthetic systemic toxicity among multi-specialty postgraduate residents. J Anesth. 2015; 29:(2)299-302

Skidmore R, Patterson J, Tomsick R. Local anaesthetics. Dermatol Surg. 1996; 22:(6)511-22

Vandendriesen N, Lim W, Paech M. Labour ward midwifery staff epidural knowledge and practice. Anaesth Intensive Care. 1998; 26:(4)411-9

van der Nest L. Local anaesthetic agent systemic toxicity. Continuing Medical Education. 2012; 30:(6)215-216

Walsh A, Moran B, Walsh S. Knowledge of Local Anaesthetic Use Among Dermatologists. Dermatol Surg. 2012; 38:(6)882-7

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

02 February 2018
Volume 26 · Issue 2



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.


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.


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.


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.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month