Critical illness complicating lipid emulsion therapy for local anaesthetic systemic toxicity in a post-hepatectomy patient with rectus sheath catheter analgesia.

A post-hepatectomy patient with acute liver injury, renal failure and hypercarbic respiratory failure who received ropivacaine rectus sheath catheter analgesia developed altered mental status, perioral numbness, hypotension and new conduction abnormalities highly suspicious for local anaesthetic systemic toxicity. Although this patient initially responded to intravenous lipid emulsion therapy with resolution of his perioral numbness and hypotension, his multisystem critical illness progressed, which makes establishing a time course of clear diagnoses and therapeutic responses complex. It is possible, given the temporal association, that the high-dose lipid therapy contributed to his rapid development of acute respiratory distress syndrome, acute pancreatitis, laboratory interference and dialysis circuit obstructions.