The awareness of local anaesthetic systemic toxicity among registrars from surgical disciplines at a tertiary hospital, South Africa

Abstract

Background: The use of local anaesthetic (LA) agents has transformed medicine and enhanced the development of surgery. Local anaesthetic systemic toxicity (LAST) is a life-threatening incident that may occur following administration of LA agents. A sound knowledge of LAST and its treatment is important for patient safety. Surveys done at many hospitals demonstrated a lack of knowledge regarding LAST and the management thereof by non-anaesthetists. The aim of this study was to assess knowledge and awareness of LAST among registrars from various surgical disciplines at Tygerberg Academic Hospital (TBH).
Methods: We performed a descriptive cross-sectional study. A web-based questionnaire was sent to 201 registrars from different surgical disciplines at TBH. The results were analysed using descriptive statistics.
Results: We received 102 responses (response rate 51%). The mean knowledge score was 67.9%, standard deviation (SD) 15.2, with a range of 20–100%. Only 18.6% of the registrars had encountered a case of LAST in their practice. Approximately 50% of the registrars knew the maximum recommended dose of bupivacaine and 54% indicated that they had previous training in the management of LAST. Only 40.2% of the registrars knew the specific treatment of LAST. The knowledge score was higher for those who had previous training in the management of LAST with a mean (SD) of 73% (13.7). A statistical difference (p-value = 0.045) between the years of training and the knowledge about LAST was demonstrated.
Conclusion: Registrars’ knowledge and awareness of LAST and safe use of LA agents were concerning. This was shown to improve with years of registrar training as well as with previous training specifically about LAST. A lack of knowledge was found in identifying lipid emulsion as the specific treatment of LAST. These factors can be improved by training and awareness campaigns.