Local Anesthetic Resistance

[Ligament]

I have a new patient who gets a painful localized rash at the injection site of local anesthetics. I have never injected her, just acquired her.

She states she does indeed get anesthesia of the injected site below the skin, but the skin itself becomes hot red swollen. She denies nickel allergy (has been formally tested for that, I thought perhaps the nickel in the needle shaft was the problem).

It appears she has only been injected with lidocaine and marcaine.

I'm sending her to allergy/immunology for testing of all common anesthetics to see which do not cause a rash.

Anybody with similar experience?

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[lobelsteve]

One true allergy. Had to get dental carpuject of septocaine or something.

 

[emd123]

Why don't you just use procaine (ester) or diphenhydramine 1%? It doesn't sound like a very serious allergy, other than mild hypersensitivity.

 

[Ligament]

Thanks guys I agree it does not sound like a real allergy, however the rashes she gets are extremely painful for 4-5 hours, so I'd like to avoid that for her.