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Dental Anesthesia

Anesthetic allergy

01/15/2009

Question:

Are there any effective local anesthetics that are not of the "cain" type? A patient that I have has been told that she is allergic to any cain lidocain septocain prilocain etc. She is not willing to have general anesthesia. Her reactions to cains included respiratory distress itching a and the subsequent use of epi and benedryl to gain control so I am hesitant to try any of this class of drugs.

Answer:

There is really no "caine" family, although all local anesthetics have "caine" at the end of them. For instance, procaine (Novocain), lidocaine, and cocaine are all very different structures and therefore not necessarily cross-allergic.

That being said, I assume this patient is allergic to amide local anesthetics. Sometimes, this does not apply to every single drug so it may be of value to the patient to be allergy tested with all available local anesthetics used for dentistry and dental cartridges should be provided as there is no methylparaben in the cartridges.

Procaine may be tried but has a very short half life and thus short duration of pulpal anesthesia. If the patient is truly allergic to all local anesthetics, general anesthesia is the only option. If the patient does not want to do this, we are not miracle workers. There are limited options for relief of pain during any surgical procedure.

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University