Awareness and preparedness for local anesthetic systemic toxicity among surgical clinicians: a multi-center cross-sectional survey study.

Abstract

Background: Local Anesthetic Systemic Toxicity (LAST) is a rare but potentially fatal complication of regional anesthesia and local anesthetic infiltration. Despite established treatment protocols, the extent of clinician awareness and institutional preparedness across surgical specialties remains poorly characterized.

Methods: This descriptive cross-sectional study enrolled 192 physicians from eight surgical specialties across five tertiary-level training and research hospitals in Türkiye (April-May 2025). A validated, structured questionnaire assessed LAST knowledge, clinical practices, and institutional readiness. Multivariable logistic regression identified independent predictors of correct lipid emulsion dosing knowledge, adjusting for specialty, seniority, and training status.

Results: Only 41.1% of participants had received formal LAST training. Correct identification of the recommended lipid emulsion bolus dose (1.5 mL/kg) was reported by 34.4% overall, rising to 58.2% among trained participants versus 18.1% among untrained participants (p < 0.001). On multivariable analysis, formal training (OR 6.38; 95% CI 3.21-12.68), anesthesiology specialty (OR 3.14; 95% CI 1.67-5.91), and senior academic title (OR 2.07; 95% CI 1.08-3.96) were independent predictors of correct dose knowledge. Early symptom recognition was reported by 49.5%. Aspiration before injection was performed consistently by 53.1%, and ultrasound guidance by 38.5%. Lipid emulsion was readily available in only 29.2% of departments.

Conclusion: Significant gaps exist in LAST knowledge, preventive practices, and institutional preparedness across surgical specialties. Targeted simulation-based education, mandatory availability of lipid emulsion, and standardized institutional protocols are warranted to improve patient safety.