# Case Report: Local anesthetic systemic toxicity during regional anesthesia in a patient with rheumatoid arthritis

## TL;DR

A 69-year-old woman with rheumatoid arthritis experienced life-threatening toxicity from a local anesthetic during surgery, highlighting the need for caution in similar patients.

## Contribution

This case report suggests rheumatoid arthritis may increase the risk of local anesthetic systemic toxicity due to vascular changes.

## Key findings

- A patient with rheumatoid arthritis showed central nervous system symptoms of LAST during regional anesthesia.
- The case suggests RA-related vascular permeability changes may predispose patients to LAST.
- Prompt diagnosis and intravenous lipid emulsion administration were critical for managing the complication.

## Abstract

Local anesthetic systemic toxicity (LAST) is a rare yet potentially life-threatening complication that requires prompt recognition and management. This condition commonly presents with manifestations that involve both the central nervous system (CNS) and the cardiovascular system (CVS). While LAST occurs infrequently during peripheral nerve blocks, its consequences can be severe if left unrecognized.

This article presents a case involving CNS manifestations of LAST in a patient with rheumatoid arthritis (RA). The patient was a 69-year-old female individual who was admitted for evaluation and treatment of a distal radius fracture previously managed at another healthcare facility and subsequently underwent open reduction and internal fixation (ORIF) at our institution. We propose that RA may constitute an additional risk factor for LAST development due to disease-associated alterations in vascular permeability.

Older patients with rheumatoid arthritis may be at increased risk for LAST due to disease-related vascular permeability changes, showing the need for increased vigilance during the administration of regional anesthesia. Early diagnosis and timely administration of intravenous lipid emulsion (ILE) remain critical for the successful management of this potentially life-threatening complication.