Systematic Review and Meta-Analysis of Lipid Emulsion for Non-Local Anesthetic Poisoning.

INTRODUCTION

Practitioners routinely use intravenous lipid emulsion for local anesthetic systemic toxicity, but its role in non-local anesthetic poisonings remains unclear. We conducted a systematic review and meta-analysis comparing lipid emulsion with standard care for non-local anesthetic toxicities.

METHODS

We searched PubMed, Embase, Scopus and Web of Science from January 1st 2010 until March 16th 2026 for human randomized controlled trials evaluating lipid emulsion for non-local anesthetic poisoning. Volunteer studies and pediatric-only studies were excluded. The primary outcome was intensive care unit admission (with intubation as a surrogate for unit-level needs). Secondary outcomes included mortality, seizures, and hospital length of admission. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effect meta-analysis was conducted. Heterogeneity was analyzed using Cochran's Q and I2.

RESULTS

Twelve studies with 816 patients were included, predominantly using 20% SMOFlipid® 280 - 500 mL. Lipid emulsion reduced intensive care unit admission compared to standard care (RR=0.70; 95% CI: [0.53, 0.93], 8 studies, n=369) with moderate heterogeneity (Q=9.43, p=0.02; I2=32.12%). Lipid emulsion also reduced mortality (RR=0.65; 95% CI: [0.53, 0.80]) and length of admission (Mean diff. =-34.16; 95% CI: [-42.29,-26.02]). Seizure incidence was lowered but not significantly (RR=0.27; 95% CI [0.06, 1.26]).

DISCUSSION: Intravenous lipid emulsion is associated with reduced intensive care unit admission and mortality for aluminum phosphide and organophosphate poisonings and a reduced length of admission for aluminum phosphide, organophosphate, and antipsychotic poisonings. The evidence is limited by study heterogeneity and study quality. Larger, high-quality trials are needed to confirm benefit.

REGISTRATION NUMBER: CRD42025645519.