Maximal Dosage of Local Anesthetics in Regional Anesthesia Techniques: narrative review and experts’ advice

Abstract

Local anesthetics (LAs) are the cornerstone of regional anesthesia (RA), offering targeted nerve blockade with a favorable safety profile when used within recommended dosages. However, determining the maximal recommended dose remains a critical concern, as exceeding this limit may result in local anesthetic systemic toxicity (LAST). This article provides an overview of the factors determining maximal dosages of LAs in RA, the inherent limitations and relativity of the published maximal dosages, the clinical implications of these dosages, and strategies to mitigate associated risks. Further research and refined guidelines are encouraged to enhance patient safety in this evolving field.

We discuss guidelines and clinical insights from recent literature, with the goal of supporting clinicians in optimizing both efficacy and safety.