Adverse Effects of Lidocaine: Literature Review

Madison Phillips

Dental Hygiene Department, South College Nashville

RDH1310-N30: Dental Pharmacology

Ms. Sarah McKinney

May 31, 2022

Article 1 Summary, Assessment & Evaluation: Lidocaine: A Local Anesthetic, Its Adverse Effects and

Management

The article discusses the prevalence of local Anesthetic in dentistry. Lidocaine is very commonly

put in this group. Other drugs used in this group include mepivacaine, bupivacaine, etidocaine, prilocaine

and articaine. All of these are considered amides. The dosage for these drugs are determined by gender,

weight, age and all of the medical conditions that the patient presents with. In table 1.(pg.) The maximum

dosage of lidocaine in adults is 500 mg and in children it is 300 mg. According to the Article, “lidocaine,

also known as lignocaine, is a class Ib antiarrhythmic and local amino amide-based anesthetic that has

been marketed since 1948”. This means it has multiple uses, it's used for chronic and acute pain. An

example of acute pain would be to relieve pain after dental surgery. Lidocaine can be administered in

different ways, topically, by injection and inhalation. The way of administration can help determine

adverse reactions when using lidocaine. Administering the wrong dosage of lidocaine can be lethal.

Lidocaine has a 10% mortality rate .(pg 2) Antioxidants and preservatives in lidocaine may be the reason

for a reaction to the drug. The article states that esters products are the most common to cause an allergic

reaction. (pg. 2) There are many things that may contribute to an adverse event due to LA exposure.

These factors include irrational needle fear, liver and kidney dysfunction, maximum prescribed dosage

and recurrent drug interactions. Anxiety plays a large role in this as well. It is very important to know the

difference between an adverse reaction and a true allergic reaction, this will allow the clinician to treat the

patient efficiently. Common symptoms of allergic reactions include anaphylaxis, urticaria,edema,

unconsciousness, hyperventilation, nausea, vomiting, and changes in heart rate or blood pressure.

The last thing the article discusses is the procedures that should be followed when a patient is

experiencing an allergic reaction to local

Article 2 Summary, Assessment & Evaluation : Anaphylactic reaction after local lidocaine infiltration

for retraction of retained teeth

 The article discusses the prevalence of allergic reactions in clinical practice. The case report was

over an elderly woman( age 86) who was complaining of three retained teeth roots. She was prescribed

amlodipine, aspirin and antihypertensive medication. Her blood pressure is not well controlled and they

stopped the administration of aspirin a week before the surgery. She took no premedication before she

could go in on the day of her surgery. Her blood pressure when she got to the dentist office was 160/70

mmHg. The dentist administered 108 mg of preservative-free lidocaine without epinephrine. The surgery

went by with no issues and took fifteen minutes. Within three minutes after walking into the waiting room

she started experiencing itching and a heat sensation. Next, her scalp and periauricular area had turned

reddish. She then experiences extreme sweating and abruptly loses consciousness. During this reaction

the dentist administered chlorpheniramine while being monitored by an ECG and being supplied oxygen.

Her blood pressure at this time was 49/38 mmHg. They then administered 10mg of ephedrine and

Hartmann's solution. The patient's vitals slowly began to rise. The dentist recommended the patient go to

an allergist to get further testing and she refused. There are two types of allergic reactions in this article.

These types include non immune mediated and anaphylaxis reactions. The way to tell the difference

between the two types is a test that finds specific igE’s , An example of this is a skin prick test. The

article explains how it is common for patients to refuse further testing but they can . The dentist will use

their best judgment and evidence to say that it was lidocaine that gave them this reaction. The dentist will

look at the patient's medical history, clinical symptoms and the medications the patients are on at the time.

Article 3 Summary, Assessment & Evaluation: Dental anesthesia for patients with allergic reactions to

lidocaine: two case reports

This article discusses two case reports regarding patients that had an adverse reaction due to the

use of lidocaine. In the case one report a female patient (54 years of age) was having issues during dental

treatment for periodontal disease . The symptoms she was having included, clouds of consciousness,

hearing impairment, and chills. (pg 210). In case two a female (age 41) presented at the dentist for a root
canal treatment and was given an injection of lidocaine containing epinephrine. The patient , within thirty

minutes, began having symptoms. The symptoms included dizziness and systemic urticaria .

The patients from case 1 and 2 both were sent to the department of allergy to have a skin prick performed.

A skin prick test is a universally accepted way to diagnose allergies. Patient 1 was tested with

bupivacaine and it was negative. Bupivacaine injections gave the patient symptoms of drowsiness to the

point of not being able to hold her eyes open. Patient 2 skin prick tested with many different drugs along

with lidocaine and was the only positive result. The dentist had to then use levobupivacaine to reduce

pain and continue his work at a later date.

Article Comparison:

Article 1 was a description on what lidocaine products contain and how they react with the body.

It also described how to identify and manage allergic and adverse reactions to lidocaine.Article 1 also

describes allergy testing procedures, similar to article 2 and 3. Article 2 and 3 use real life clinical

examples on how a patient may seem during an allergic/adverse reaction to lidocaine. All three of the

articles agreed on the fact that adverse and allergic reaction to lidocaine is rare. They all state that the rate

of occurrence of an allergic reaction is less than 1%. Article 2 and 3 also discusses how fear and anxiety

initially have similar symptoms to allergic reactions. The articles also discuss the difference between ester

and amide local anesthetic classifications. Ester is more common to trigger an allergic reaction than

amides.

Conclusion:

In conclusion adverse reactions to lidocaine is rare but it does happen in the dental setting due to

its common use. Understanding how lidocaine works in the body and how it is administered can help the

clinician on how to spot an allergic or adverse reaction. Knowing appropriate dosage of lidocaine

regarding a patient's weight, age, gender and medical conditions prepare the clicican to provide safe and

effective care . This knowledge of all this could save a patient's lives.
 References:

Bahar, E., & Yoon, H. (2021). Lidocaine: a local anesthetic, its adverse effects and

management. Medicina, 57(8), 782.

Kim, H., Lee, J. M., Seo, K. S., Kwon, S. M., & Row, H. S. (2019). Anaphylactic reaction after local

lidocaine infiltration for retraction of retained teeth. Journal of dental anesthesia and pain

medicine, 19(3), 175-180.

Lee, J., Lee, J. Y., Kim, H. J., & Seo, K. S. (2016). Dental anesthesia for patients with allergic reactions

to

lidocaine: two case reports. Journal of dental anesthesia and pain medicine, 16(3), 209-212.