Use of lipid emulsion to reverse the effects of regional anesthesia: A novel indication.

Abstract

A reported novel use of intravenous lipid emulsion (ILE) therapy is to reverse the local anesthetic effects on nerves with peripheral regional and neuraxial anesthesia. This is not well-established, therefore a review of the literature was undertaken. Medline and Embase databases were searched, as well as Google for grey literature. Indexed and non-indexed literature discussing ILE administration for regional and neuraxial anesthetic blocks were identified. Cases of Local Anesthetic Systemic Toxicity (LAST) were included, provided they also described reversal of peripheral or neuraxial blockade. Our search revealed fifteen patient case reports, but no clinical trials or review articles. Two indexed reports originating from the USA demonstrated rapid reversal of peripheral nerve blockade following administration of ILE therapy for LAST. A further two indexed USA cases of inadvertent total spinal anesthesia showed prompt resolution of hemodynamic compromise and progressive recovery of motor and sensory function after ILE infusion. Unindexed reports originating from Vietnam elucidated seven cases of spinal/epidural anesthesia and four cases of peripheral regional anesthesia in which motor and sensory neurological deficit attributable to the local anesthetic appeared to be reversed by ILE administration. These reports explore several novel uses for ILE outside its established role in the treatment of LAST. ILE may have applications in (1) The treatment of high or total spinal anesthesia, (2) The treatment of unintended or prolonged peripheral nerve blockade, and (3) Hastening recovery of sensory and/or motor function following uncomplicated neuraxial or peripheral regional anesthesia. However, these reports are only hypothesis generating. Further research is required to assess a causal relationship.