Q: What is the minimum dose of intravascular lidocaine to result in toxicity? show answer
Intravascular injection of local anaesthetic
Patient presented to a musculoskeletal imaging centre for a routine MR hip arthrogram.
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Initial fluoroscopic image was felt by the operator to have confirmed intra-articular positioning due to a small bleb of contrast visualised lateral to the ischial tuberosity, indicating contrast 'free flowing' into the joint space. Follow up fluoroscopic image revealed complete absence of contrast in the joint and 'washout' of the contrast from its initial position.
The patient was undergoing a routine pre- MR arthrogram joint injection by an experienced operator.
The second fluoroscopic image was performed after administration of a solution containing 50mg ropivacaine (0.5%, 5mg/ml), 10ml normal saline and 0.1ml Gadolinium.
The MR image confirms the absence of intra-articular contrast and inadvertent intravascular injection due to contrast within the bladder.
AgentMinimum Toxic Dose (mg/kg)
- Goldfrank LR, Flomenbaum NE, Lewin NA, et al. 1507-17. In: Goldfrank's Toxicologic Emergencies. 6thed. New York: McGraw-Hill; 1998:897-903.