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Checklist for Treatment of Local Anesthetic Systemic Toxicity (LAST)

Nov 1, 2020, 00:00 AM by ASRA Pain Medicine

Local anesthetic systemic toxicity (LAST) is a rare but life-threatening complication of regional anesthesia administration. Practitioners should be prepared to respond quickly to a local anesthetic overdose. ASRA convened a symposium on LAST in 2001 which led to a series of articles addressing potential treatments. In 2008, ASRA created a Practice Advisory on Neurological Complications of Regional Anesthesia and Pain Medicine, and in 2010, the ASRA Local Anesthetic Systemic Toxicity checklist was developed to guide management. The checklist has been revised over the years based on additional evidence and advances in medical knowledge. Authors Joseph M. Neal, Erin J. Neal, and Guy L. Weinberg revised the checklist again in 2020. 

Read the 2020 report. 

LAST Checklist

Copyright © 2020 by the American Society of Regional Anesthesia and Pain Medicine.


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Scholarly publication of these recommendations should be cited as: Neal et al Publication or reproduction of the checklist for commercial use requires written permission from ASRA Pain Medicine. Graphic: Erin J. Neal. ACLS, Advanced Cardiac Life Support; LAST, Local Anesthetic Systemic Toxicity.

Download the full printable checklist (PDF)

Download checklist in Spanish (Thank you to Drs. Xabier Ormazabal  and Carlos Pino for translation assistance.)

Request other formats (eg, JPG, PNG) by contacting us at

This checklist was published November 1, 2020, and will be reviewed again in 2025.




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