Rising Lidocaine Poisonings Raise Concerns Over Misuse and Underestimation of Risk
A recent study published in Regional Anesthesia & Pain Medicine highlights a concerning trend: a significant increase in fatal lidocaine poisonings, particularly across the Atlantic. Between 2016 and 2021,deaths attributed to lidocaine – a commonly used local anesthetic – rose by 50%,with a tripling of mortality over the past decade.
while long considered a safe medication,readily available over-the-counter in creams,gels,patches,and sprays at concentrations of 4-5%,lidocaine is now implicated in 82% of deaths related to local anesthetics,a rise from 67% in 2010.
Shifting Patterns of Use and Exposure
The increase in poisonings isn’t due to a change in the product itself, but rather a shift in how it’s being used. A growing number of incidents are occurring outside conventional medical settings – at home, in offices, and in ambulatory care centers where anesthesia training may be limited.
The study authors cite alarming examples, including a patient experiencing cardiac arrest after receiving lidocaine as a rinsing solution during an MRI, and another becoming unconscious after inhaling lidocaine powder purchased online to self-treat stomach burns.
Understanding Lidocaine Toxicity
High doses of lidocaine, whether injected or absorbed, can lead to serious systemic toxicity, impacting both the central nervous system and the heart. Symptoms can range from convulsions and irregular heart rhythms to cardiac arrest.
Dr. Michael Fettiplace, lead author of the study and a professor at the University of Illinois in Chicago, emphasizes that “Lidocaine is not as safe as you think.” The ease of access, including over-the-counter availability, contributes to a false sense of security. Some formulations contain up to 2000mg of lidocaine, significantly exceeding the recommended maximum adult dose of 300mg.
The study also points to a rise in medical procedures performed outside of hospitals, particularly in cosmetic surgery and dermatology, where larger doses may be administered without adequate monitoring. The delayed onset of lidocaine toxicity, coupled with the lack of specialized equipment in these settings, hinders effective emergency management.
Treatment and Underreporting
An effective antidote, “lipid emulsion therapy” (lipid rescue) – an intravenous injection of lipids that neutralizes the toxin – exists. However, prosperous treatment relies on healthcare professionals recognizing the signs of an overdose and having access to the necessary equipment.
Researchers believe the actual number of lidocaine-related accidents is significantly underestimated,with manny cases incorrectly attributed to othre causes. Similar concerns were raised in the 1970s and 80s regarding lidocaine used to treat cardiac arrhythmias, but the full extent of the problem was never fully understood.
The widespread use of lidocaine, including in personal first-aid kits, is based on a long-held reputation for safety that may no longer be accurate. In France, and similarly in other regions, lidocaine products are readily available without specific warnings regarding systemic risks associated with misuse.
As ambulatory care expands and more medical procedures are performed outside of traditional hospital settings, this case underscores the potential dangers of readily available medications perceived as harmless.
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