Marcaine allergy and approach

[ghost dog]

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Hey folks.

I have a patient who received a labour epidural 35 years ago with Marcaine, and states that she was told "not to receive Marcaine again". The only info I can get off her is that her BP dropped. I can't get other relevant anaphylaxis sxs off her. It sounds to me like she likely had a local anesthetic rxn, as opposed to a true allergic rxn, considering the true extreme rariety of LA allergy.

I have a few questions here:

1. Is it true that amides don't cross react if a patient is truely allergic to one (in this case Marcaine) ? i.e. would it be reasonable to attempt lidocaine then ?

2. I have read in other threads that a marcaine skin test with a 30 min observation period is reasonable. Agree or disagree? If agree, what test dose of Marcaine would be reasonable to give?

Cheers.

 

[lobelsteve]

Hey folks.

I have a patient who received a labour epidural 35 years ago with Marcaine, and states that she was told "not to receive Marcaine again". The only info I can get off her is that her BP dropped. I can't get other relevant anaphylaxis sxs off her. It sounds to me like she likely had a local anesthetic rxn, as opposed to a true allergic rxn, considering the true extreme rariety of LA allergy.

I have a few questions here:

1. Is it true that amides don't cross react if a patient is truely allergic to one (in this case Marcaine) ? i.e. would it be reasonable to attempt lidocaine then ?



2. I have read in other threads that a marcaine skin test with a 30 min observation period is reasonable. Agree or disagree? If agree, what test dose of Marcaine would be reasonable to give?

Cheers.

Amides and esthers do not cross react, but you are describing a side effect and not an allergy.

You can always give .5cc subq and observe for 30 min. Have cart nearby as well as Rosenthal's paper reviewed.

 

[dc2md]

You can always give .5cc subq and observe for 30 min. Have cart nearby as well as Rosenthal's paper reviewed.

Which paper is that?

 

[lobelsteve]

Which paper is that?

http://www.nexuspaincare.com/pdf/22.pdf

 

[Tenesma]

the hypotension could have been just too much local...

don't stress about it - just refer to local allergist to figure things out - that way you are protected and patient re-assured.

 

[specepic]

the hypotension could have been just too much local...

don't stress about it - just refer to local allergist to figure things out - that way you are protected and patient re-assured.

Agree, turf to allergy

 

[ghost dog]

Amides and esthers do not cross react, but you are describing a side effect and not an allergy.

You can always give .5cc subq and observe for 30 min. Have cart nearby as well as Rosenthal's paper reviewed.

Thanks for the feedback; much appreciated.

Of course - this patient no shows on me.

No show for a consult today too. Bad mo jo today. I don't think I have had a day like this in a long time (if ever).