The state of local anaesthetic systemic toxicity in 2025: the emergence of lidocaine as our next challenge.

Overview

Local anaesthetics are an integral part of surgical and medical practice, but their systemic uptake can result in local anaesthetic systemic toxicity (LAST). A recent study by Fettiplace and colleagues examined the US Food and Drug Administration's Adverse Events Reporting System between 1968 and 2023. Although the reporting of death from long-acting local anaesthetics decreased after the publication of relevant practice advisories, Fettiplace and colleagues also found that deaths from lidocaine remained essentially unchanged. The emergence of lidocaine as the leading reported cause of deaths attributable to LAST was unexpected, and the reasons behind the relatively higher number of deaths from lidocaine-induced LAST are not clear. One of the major limitations to this study is the lack of data on population-level local anaesthetic administrations.