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Thursday, July 31, 2014
Allergy to Lignocaine
Could you please assist me in advising which alternative local anesthetic I can I use as a need a steroid injection in lumbosacral spine. Local anesthesia with lignocaine can not be applied as I am allergic, also to penicillins, perindopril, sibutramine, sulfonamides, tramal, and zyban. Thank you
Local anesthetics are divided into two main groups - esters and amides. These terms refer to the chemical structure of the drug. Lignocaine is an amide local anesthetic so a person who is allergic to lignocaine should avoid other drugs in the same group, such as bupivacaine, mepivacaine and ropivacaine. (Lignocaine is known as lidocaine in North America). The alternative choice would be an anesthetic in the ester group, such as procaine (Novocaine) or chloroprocaine.
Allergy to lignocaine is well documented but is rare. Many patients are labelled as allergic after some form of unpleasant experience at the dentist where lignocaine may be used to block dental nerves, but which is not actual allergy.
An additional consideration for any spinal injection is that the drug preparation must be preservative free. This means that some of the standard local anesthetic preparations cannot be used.
Your anesthesiologists obviously must be told about your allergy. The more detail you can provide about the symptoms and circumstances the better. He/she can then select the best choice for you, which will also depend on what is available in your hospital.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University