Local anaesthetics in interventional radiology: a primer for radiologists on applications and management of complications

Local anaesthetics (LAs) allow a range of procedures to be performed in interventional radiology (IR) through improving patient comfort and reducing pain. This review serves as a primer for interventional radiologists, providing an overview of commonly used LAs and practical tips for their implementation. With its quick onset time and moderate duration of action, the amide lidocaine is the most used and applicable to a variety of procedures such as biopsies and embolization. In contrast, bupivacaine and ropivacaine (both amides) have longer durations of action, and are therefore suitable for lengthy procedures and pain control post-procedurally. Procaine, an ester, may be used in cases of amide anaesthetic allergies. This review examines the clinical applications of LAs in radiology and management of their adverse effects including local anaesthetic systemic toxicity (LAST) and allergic reactions. It concludes with a discussion of LAST, emphasising techniques for early intervention and management. The role of lipid emulsion therapy and modifications to the advanced cardiac life support (ACLS) protocol are highlighted, including a discussion of other aspects such as airway management. By presenting the latest strategies to manage LAST and adverse effects, this research aims to help standardise anaesthetic management in radiology. It provides actionable steps for selecting and injecting anaesthetics, and management of complications that will be beneficial for interventional radiologists performing a diverse array of procedures.