Operating Room Black Box Technology to Mitigate Local Anesthetic Systemic Toxicity Risk Associated With Liposomal Bupivacaine Administration.

Purpose: This quality improvement project used operating room black box (ORBB) technology to evaluate adherence to liposomal bupivacaine (LB) administration protocols, specifically to identify obstacles to compliance with these protocols to mitigate the risk of local anesthetic systemic toxicity (LAST).

Design: The team conducted a retrospective chart review of surgical cases using ORBB technology in two robotic operating rooms at a tertiary academic medical center.

Methods: The project included 39 patients who received intraoperative LB between November 2022 and February 2024. Data were collected from the ORBB recordings and electronic medical records, focusing on provider adherence to LB administration protocols, such as conducting LB time-outs, applying LB alert wristbands, discontinuing lidocaine infusions, and following a 2:1 admixture ratio of LB with bupivacaine hydrochloride.

Findings: Chart review indicated 25 (64%) cases completed the LB time-out, 24 (62%) applied the LB wristband intraoperatively, 23 (59%) included a wristband check, and 14 (36%) incorporated lidocaine infusion checks during the LB time-out. One case failed to stop the lidocaine infusion and 3 cases failed to follow the correct 2:1 admixture ratio; however, no LAST cases were reported.

Conclusions: These findings underscore the potential of ORBB technology in improving adherence to LB administration protocols, reducing the incidence of LAST (10.2%), and enhancing patient safety. Challenges such as blind zones in ORBB coverage, the Hawthorne effect, and potential litigation risks are acknowledged. Information and training about ORBB technology, sharing ORBB reports with staff, and cross-referencing ORBB data with electronic medical records are recommended to optimize patient outcomes.