Local Anaesthetic Systemic Toxicity (LAST) is a life-threatening complication of regional anaesthesia that requires prompt recognition and intervention. This article discusses the clinical presentation, risk factors, management, and prevention strategies for LAST. Symptoms can present immediately or with a delayed onset, particularly in fascial plane blocks. Early signs include altered mental status, perioral tingling, and agitation, progressing to seizures and cardiovascular collapse. Immediate management involves stopping the local anaesthetic, securing the airway, administering 100% oxygen, anticonvulsants for seizure control, and intravenous lipid emulsion therapy (ILE) as the definitive antidote. In cases of cardiac arrest, prolonged resuscitation and cardiopulmonary bypass may be required. The risk of LAST varies by block site, with intercostal blocks carrying the highest risk. Ultrasound guidance, incremental dosing, and frequent aspiration help reduce risk. The CVS:CNS toxicity ratio of local anaesthetics determines the likelihood of cardiovascular collapse relative to central nervous system toxicity, with bupivacaine posing a higher risk than lidocaine. This review highlights the evolving presentation of LAST with the increasing use of ultrasound-guided regional anaesthesia and the importance of having a lipid rescue kit readily available in all anaesthetic areas.