Local Anesthetic Systemic Toxicity (LAST) - a Review and Update

Purpose of Review This article reviews the incidence, presentation, risk factors, and treatment for local anesthetic systemic toxicity (LAST). We have specifically focused on the changing patterns in practice, presentation, and recent updates on treatment. Recent Findings Regional anesthesia is now an essential component of perioperative care with enhanced recovery programs, multimodal analgesia regimen, and the opioid crisis. Local anesthetics are widely used, contributing to varied presentations and increased incidence of LAST outside the operating room. Use of intravenous lipids for treatment of LAST has increased, but there is still deficiency in timely, appropriate use. Recent studies have given us a better understanding on the mechanism of action of lipids. Summary LAST though rare continues to happen in different patterns and locations. Updated knowledge is required to prevent and manage this dreadful complication. Anesthesiologists can lead in training and educating others, in prevention and management of LAST.