Lidocaine overdose after continuous systemic administration for postoperative analgesia

Abstract

SummaryWe report the case of a 77‐year‐old male who had elective duodenopancreatectomy surgery. As part of a multimodal analgesia strategy a continuous infusion of lidocaine was administered peri‐operatively. Surgery was uneventful. On admission to post‐operative Intensive Care Unit (ICU), the patient presented with progressive neurological and haemodynamic failure due to a lidocaine overdose made by an error in the continuous systemic administration. Once the diagnosis was established, an infusion of lipid emulsion resulted in almost immediate haemodynamic recovery; full neurological recovery was however delayed for some hours. Continuous intravenous infusions of lidocaine can lead to systemic toxicity, therefore training in lidocaine administration, diagnosis of toxicity and its management are essential for all staff involved in the care of these patients.