Local anesthetic systemic toxicity: An effort to identify knowledge gaps across specialties

Introduction: Physical medicine and rehabilitation (PM&R) physicians are trained to perform interventional procedures using local anesthetics (LAs) to reduce pain and enhance function and quality of life. LA administration is not benign and one potential complication is local anesthetic systemic toxicity (LAST). Anesthesiologists also perform interventions with LAs; however, training on LAST may differ between medical specialties. Objective: To investigate if a gap exists in the knowledge of LAST between physiatry and anesthesiology physicians. Design: Prospective cross-sectional survey study. Setting and Participants: All residents, fellows, and attendings of the anesthesiology and PM&R departments at a single academic medical center. Outcome Measures: The primary outcome measures include participants' self-reported exposure to LAST education and comfort with their LAST knowledge as recorded on a Likert scale, as well as the percentage of correctly answered knowledge-based questions on the topic. Results: Fifty-eight physicians including 28 PM&R and 30 anesthesiology physicians (24 attending and 34 trainees) participated. Anesthesiology trainees and attendings exhibited greater overall perceived knowledge of LAST (trainees U = 43, p <.001; attendings U = 9, p <.001), with greater exposure to LAST education (trainees U = 16.5, p <.001; attendings U = 12, p <.001). Assessment of responses to knowledge-based questions on LAST revealed a statistically significant knowledge gap between PM&R and anesthesia trainees (t = 6.62, p = <.001) as well as between attending groups (t = 3.25, p = <.01). Conclusion: This study reveals a distinction in both the subjective and objective knowledge of LAST between PM&R and anesthesiology physicians at a single academic institution. This suggests that there is opportunity for further assessment of the education on LAST among physiatrists and residents in training.