FEBRUARY 26, 2026
ORLANDO, Fla.—A new analysis has uncovered a troubling increase in lidocaine-related deaths across the country since 2010. Although nerve blocks have largely disappeared as a source of reported deaths in that period, IV lidocaine has risen as a cause of mortality, as have deaths reported in emergency settings and with large IV doses.
“Over the years, I have heard of several cases of death from LAST [local anesthetic systemic toxicity],” began Michael Fettiplace, MD, PhD, an
ORLANDO, Fla.—A new analysis has uncovered a troubling increase in lidocaine-related deaths across the country since 2010. Although nerve blocks have largely disappeared as a source of reported deaths in that period, IV lidocaine has risen as a cause of mortality, as have deaths reported in emergency settings and with large IV doses.
“Over the years, I have heard of several cases of death from LAST [local anesthetic systemic toxicity],” began Michael Fettiplace, MD, PhD, an assistant professor of anesthesiology at the University of Illinois Chicago. “And while other researchers have calculated rates of LAST with peripheral nerve blocks in various surgical procedures, we chose to take a broader look at all adverse events associated with local anesthetic usage.
“From there the question came up of how mortality has changed in the last 10 years, following the implementation of practice advisories for treating LAST by multiple anesthesia societies,” he added.
To do so, Fettiplace and his colleagues turned to data from the National Poison Data System, hypothesizing that the 2010 recommendations contributed to a reduction in reporting and mortality from local anesthetics. As part of that effort, they compared the 2001-2010 period with that of 2011-2022.
Reporting at the 2025 annual spring meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine; abstract 6481), the investigators said between 1983 and 2022, the case fatality rate of LAST was 0.036% (74 local deaths in 203,853 reports of LAST), less than the 0.049% total fatality rate in the database (39,913 total deaths in 79,360,369 total reports).
It was also found that after the introduction of professional society practice advisories in 2010, reports of LAST decreased, from 78,400 to 65,173 (P<0.001). However, reports of death from LAST rose from 14 to 41 (P=0.016).
More specifically, the reduction in LAST was driven by a decrease in events not related to lidocaine. On the other hand, reports of lidocaine poisoning increased from 17,384 to 22,349 and mortality from lidocaine increased from nine to 33 over the same period. The mortality increase with lidocaine was confirmed by the analysis.
“We saw that over the past 10 years, there’s been a gradual rise of the number of reports of lidocaine poisoning,” Fettiplace said in an interview with Anesthesiology News. “The more surprising thing is that there was a drastic rise in the number of reports of death associated with lidocaine.
“I think that has to do with a number of factors, but the recurrent theme is that people are either self-administering or a medical professional is administering extremely large doses of lidocaine. Most of these patients were getting something like 2 g of lidocaine.”
An exploratory analysis of the described cases of death revealed that 67% used lidocaine between 1985 and 2010, while 82% used lidocaine during the 2011-2022 period.
Further exploration of the database showed that between 1985 and 2010, 33% of cases were related to ingestion or inhalational, 10% were nerve blocks, and 3% were IV related. Between 2011 and 2022, however, those percentages changed to 19%, 0%, and 27%.
“There were previous multiple documentations of poisoning and death from nerve blocks,” Fettiplace explained. “But anesthesiologists now get rigorous education on the bad things that happen in association with nerve blocks. We’ve also gotten better at using ultrasound to identify structures and avoid giving big doses intravascularly. Generally speaking, we’re more cautious about what we do, but it seems as we’re not cautious enough in other situations with lidocaine, I assume because everyone thinks it’s so safe.”
With respect to delivery location, the OR represented 47% of cases from 1985 through 2010, but only 15% from 2011 through 2022. Conversely, the prehospital setting (emergency medical services or emergency department) ballooned from 7% to 31%.
The other striking finding was that almost every case of lidocaine death comprised doses of the drug that exceeded the recommended upper limit, including doses as high as 48,000 mg before 2011 and as high as 4,425 mg after 2011.
“I can go on the internet and buy 24 g of lidocaine right now and have it delivered to my door tomorrow,” Fettiplace said. “That’s crazy, particularly because people don’t necessarily understand the dangers associated with it.”
If anything, the escalation in lidocaine-related deaths underscores the significant—yet often overlooked—risks associated with the drug. As Fettiplace concluded, they also highlight the need for improved guidance on lidocaine usage and strategies.
“We’re currently organizing the next ASRA guidelines or practice advisory on LAST,” he noted. “From my perspective, the data are compelling enough that the next step is to try to implement positive change and reduce these adverse events.”
Christopher L. Wu, MD, said part of the issue stems from increased use of lidocaine by non-anesthesiologists in non-OR environments, coupled with a general lack of familiarity regarding toxic doses of the agent.
“People may not necessarily be familiar with lidocaine toxicity because they’re not really trained with that in mind,” said Wu, an attending anesthesiologist at Hospital for Special Surgery and a clinical professor of anesthesiology at Weill Cornell Medicine, both in New York City. “Furthermore, when you’re inside the operating room, the anesthesiologist, the surgeon and the nurse are all on the lookout for things like local anesthetic toxicity. Outside of the operating room, though, clinicians don’t seem to have that same sense of gravity.”
With that in mind, Wu said other specialties would benefit from guidelines regarding use of local anesthetics, particularly lidocaine.
“Societies for emergency room physicians and plastic surgeons, in particular, would benefit either from adopting the ASRA guidelines, or at least modifying them to meet their specialty’s needs,” he noted. “Anesthesiologists are very attuned to this because our societies have done a great job in making this issue known. But with other societies, it’s not in their wheelhouse.”
—Michael Vlessides
Fettiplace and Wu reported no relevant financial disclosures. The research was published in Regional Anesthesia & Pain Medicine (2025 Jul 21. doi:10.1136/rapm-2025-106464).
