Local anesthesia systemic toxicity (LAST) treated as anaphylaxis

Abstract

Local anesthesia systemic toxicity (LAST) and anaphylaxis are the life-threatening adverse effects of lignocaine. Both have different presentations and treatments. We report a case of 35-year-old female who came to our Emergency Department (ED) with symptoms of lethargy, drowsiness, and difficulty breathing with foreign body sensation and a metallic taste in the throat which started 15 minutes after a right shoulder injection with 250 mg of lignocaine mixed with Triamcinolone in the Orthopedic Clinic. She was pushed to the resuscitation bay and was treated as anaphylaxis. Upon further evaluation, the blood pressure was never hypotensive, no sign of compromised airway, no gastrointestinal symptom, and no mucosal involvement which directs to the diagnosis of LAST rather than anaphylaxis. Surprisingly, she was gradually improving and was discharged home after six hours of observation in the ED. This is the first case report that LAST had been effectively treated as anaphylaxis.