“Not As Safe As We Think”: Lidocaine Deaths Nearly Triple Over Past Decade

Authored by George Citroner via The Epoch Times (emphasis ours),

Poisonings and deaths linked to the common local anesthetic lidocaine have nearly tripled in the United States over the past decade, with fatal overdoses increasingly occurring outside hospitals, where untrained staff administer the supposedly “safe” anesthetic, a new analysis shows.

Over-the-counter topical lidocaine products, which typically contain up to 4 percent to 5 percent lidocaine, are primarily used for temporary relief of pain, itching, and burning sensations. The pain reliever is available in various forms, including creams, ointments, gels, sprays, patches, and foaming soaps. However, in medical settings, it can pose risks that many people may not be aware of.

“Lidocaine is not as safe as we think,” Dr. Michael Fettiplace, study author and assistant professor at the University of Illinois Chicago College of Medicine, told The Epoch Times.

Increase Seen from 2011 to 2022

A recent study, published in Regional Anesthesia & Pain Medicine, reveals a trend hidden within America’s medical system. While overall poisonings from local anesthetics dropped 23 percent after 2010—when medical organizations issued new safety guidelines—lidocaine cases bucked the trend.

Among the risks associated with the drug, lidocaine can cause systemic toxicity when introduced into the bloodstream at high levels. This condition, known as local anesthetic systemic toxicity, primarily affects the central nervous system and cardiovascular system, potentially leading to seizures, arrhythmias, and even cardiac arrest.

Fettiplace’s team had documented increasing toxicity cases in medical literature, but underestimated how often those cases proved fatal. “We identified a rise in mortality events associated with lidocaine, which was unexpected,” he said. “In retrospect, it is not surprising.”

The study analyzed more than 200,000 poisoning cases reported to U.S. poison control centers between 1983 and 2022, including 74 deaths from local anesthetics.

While deaths from other anesthetics declined, the proportion of fatalities linked to lidocaine rose from 67 percent in 2010 to 82 percent in recent years. Overall, 0.1 percent of lidocaine poisoning cases resulted in death, compared with 0.01 percent for other local anesthetics.

In absolute numbers, reports of lidocaine poisoning jumped more than 50 percent, from 1,600 cases in 2016 to 2,500 in 2021.

Many of the deaths occurred after the patient overdosed on lidocaine themselves or received an overdose in outpatient settings.

One case described a 70-year-old man going into cardiac arrest and dying after being administered a 2 percent lidocaine solution. He had undergone an outpatient cardiac magnetic resonance imaging (MRI) scan, and instead of having the MRI dye flushed with normal saline, he was given lidocaine instead.

While poisonings occurred across all age and gender demographics, cases occurred most frequently at home, Fettiplace noted.

The study described one case in which a man inhaled imported lidocaine powder from China to treat his gastroesophageal reflux disease and became unconscious.

“Undoubtedly, there is underreporting,” Fettiplace said. “I cannot predict an upper limit of the increase.”

He noted that adverse events involving lidocaine are often attributed to other causes, even when lidocaine contributed to the death—a pattern also seen when lidocaine was used as an antiarrhythmic agent in the 1970s and 1980s.

Fettiplace added that, given how frequently lidocaine is used both as an inpatient pain medication and in outpatient settings—as creams and patches—it’s possible there are a “profound number” of adverse events going unreported.

Why Lidocaine Became More Dangerous

Lidocaine is a widely used and versatile drug. It has had a consistent safety profile and has long been considered a gold standard local anesthetic. Fettiplace noted that while health care practitioners have a “healthy fear” of other potent local anesthetics like bupivacaine—which is longer-lasting and has a higher potential for toxicity, most consider lidocaine safe.

As an anesthetic, it can be used both topically, injected in the mouth for dental procedures, used to alleviate sore throats, and used for nerve blocks like epidurals.

Its ubiquity has led to an underappreciation of its potency.

In medical settings, lidocaine has been distributed for multiple or prolonged uses, such as 2,000 milligrams in a bottle or IV bag, though 300 milligrams is typically the recommended upper limit for a single adult dose, Fettiplace said.

Drivers of Deaths

The study showed that several deaths occurred after the patient was prescribed or purchased lidocaine and accidentally overdosed.

Fettiplace said that over-the-counter formulations containing 20 grams or more of lidocaine are readily available to the public—and, in some cases, have been used for self-harm.

Dr. Evan Peskin, a dual board-certified anesthesiologist and interventional pain medicine physician who was not involved in the study, told The Epoch Times that one “major issue” is the growing number of outpatient surgeries, where procedures are done outside hospitals—in clinics or office settings.

“Many of these procedures are being performed by providers who may not have formal anesthesia training,” he warned.

Peskin noted that in some cases, large amounts of lidocaine are used—such as in cosmetic procedures like liposuction—and the administering providers may not fully understand how the drug is absorbed over time or that the toxicity may not present immediately.

Treatment for Lidocaine Poisoning

When lidocaine poisoning occurs, quick action can mean the difference between life and death.

Lipid emulsion therapy—also called lipid resuscitation or intravenous lipid emulsion therapy—is a treatment that involves administering a fat emulsion intravenously to counteract the toxic effects of certain overdoses and poisonings.

When it comes to treating lidocaine poisoning, Peskin said how quickly lipid emulsion therapy is given can make a “big difference” in the outcome. “The problem is that in many outpatient settings, the people giving the lidocaine may not recognize the signs of toxicity, or they may not have lipid emulsion available,” he added.

Peskin emphasized that delays in treatment can lead to worse outcomes, including death. “That’s why it’s essential for all locations where lidocaine is used, especially outside the hospital, to have the correct supplies and trained staff who can respond quickly if an issue arises.”