LipidRescue™ Resuscitation

A 53 y.o.70 kg female was scheduled for a right trigger finger release and right distal ulnar hemi-resection.
The patient underwent preoperative brachial plexus block via infraclavicular approach. After midazolam 2 mg sedation a median nerve twitch was achieved at 0.4 mA. Ropivacaine 0.5% with clonidine was administered in 5 ml increments with negative aspiration. After 30 ml of local anesthetic injection the patient's sensorium changed and the injection was stopped. Almost immediately seizure activity was noted.
The patient was ventilated with oxygen via facemask and intralipid was administered within 3-4 minutes. She received a bolus of 100ml of Intralipid 20% followed by IV infusion. The seizures stopped shortly after the intralipid infusion began. Blood pressure and pulse were stable throughout. After a period of time the patient awoke but appeared post-ictal and the surgery was postponed to a later date.

As an addendum to the above the case, it was noted the patient had a very dense block once her sensorium cleared.

There was no change in the ECG, and in my opinion it was impossible to determine if the lipid made a difference. I will say that these episodes can be terrifying to manage and it was very reassuring to have the lipid readily available to administer. At least the lipid does no harm and may help significantly.
I have a question for you or any else. My partner and I have performed over 8,000 regional anesthetics over the last 8 years with only 3 episodes of CNS toxicity. Most of these blocks were supraventricular bracial plexus blocks or femoral nerve blocks. Of the three blocks that resulted in toxicity two were infraclavicular. I assume this area is anatomically more vascular and more likely to result in higher blood levels of the local anesthetic than some of the other injection sites. Any comment?