Abstract
Local anesthetic systemic toxicity (LAST) remains a critical clinical concern despite major advances in regional anesthesia and pharmacologic innovation. It arises from excessive systemic absorption or inadvertent intravascular administration of local anesthetic agents, leading to severe neurological and cardiovascular complications. This review explores the underlying mechanisms of LAST, its epidemiology, and the evolving strategies for prevention and management. Recent evidence highlights the growing role of ultrasound-guided injections and the use of less cardiotoxic agents such as ropivacaine and levobupivacaine in reducing risk. Nevertheless, factors such as patient comorbidities, high-dose infusions, and delayed diagnosis continue to contribute to adverse outcomes. Prompt recognition and immediate administration of intravenous lipid emulsion therapy remain the cornerstone of treatment, while ongoing education and adherence to updated ASRA practice guidelines are crucial for prevention. Looking forward, precision dosing, pharmacogenomic assessment, and smart monitoring systems offer promising solutions to further minimize LAST incidence and improve patient safety across anesthetic practice. The study concluded that effective management hinges on early recognition, prompt intervention with intravenous lipid emulsion therapy, and continuous education through simulation and guideline adherence. It also recommended that continuous professional education should be provided for anesthetists, dentists, surgeons, and other healthcare workers on the recognition, prevention, and management of local anesthetic systemic toxicity.