Neurotoxicity of local anaesthetics (LA) and adjuvants is critical in regional anaesthesia. This article reviews the mechanisms, risk factors, and management of LA-induced neurotoxicity. Nerve injury following regional blocks is rare, with most cases resolving within a year. However, factors such as high-dose LA, intraneural injection, ischemia, and adjuvant agents can exacerbate neurotoxicity. The cellular mechanisms involve oxidative injury, mitochondrial dysfunction, and apoptosis through caspase and MAPK pathways. Lignocaine (5%) has been linked to cauda equina syndrome and transient neurological symptoms, leading to its discontinued use. Pre-existing neuropathy, diabetes, and surgical factors further increase the risk. Prevention strategies include dose limitations, careful needle placement, and avoiding high-risk adjuvants. Early recognition and neurological monitoring are crucial for patient safety.