Use of intralipid for the reversal of local anaesthetic blockade following neuraxial anaesthesia – a case series.

Abstract

Background and Aims: Neuraxial anaesthesia for caesearean section (CS) with local anaesthetics is frequently performed, however these procedures can cause high-level blockade or Local Anaesthetic Systemic Toxicity (LAST). Evidence supporting the use of intralipid as a reversal agent following high-spinals is scarce. Methods: This case series presents the reversal of two patients with high spinal blocks with intralipid emulsion. Written consent was obtained. Results: Case 1: A 27-year-old primigravid at 40 weeks 3 days of gestation was referred for a CS following foetal distress and slow labour progression. 2% lignocaine was given epidurally in 5ml aliquots (Total 20ml over 45 minutes). Postoperatively, the patient had increased work of breathing, hypotension, and bilateral upper arm weakness. This persisted for 50 minutes with block to ice at C2 bilaterally. Intralipid emulsion was given in 5-10ml alliquots (Total 50ml). Rapid block recession to T4 bilaterally within 15mins. Case 2: A 26- year-old primigravid at 38 weeks and 2 days gestation was referred for a CS due to obstructed labour. An epidural performed earlier only provided a unilateral block. A spinal neuraxial was performed. Block to ice was noted at C7 after delivery, with hypotension and increased work of breathing. 20ml of Intralipid was given, with block recession to T1. A second 20ml intralipid bolus was given and the block recessed to T4. Conclusions: Early intralipid administration rapidly reverse neuraxial anaesthesia and prevent LAST. This study supports the safe use of intralipid. Future research is required to investigate the appropriate timing and dosing of intralipid when used in such circumstances.