Allergische Reaktion vom Typ IV auf Prilocain nach Anwendung von Tumeszenz-Lokalanästhesie – eine seltene Komplikation

Gerontopoulou, Stefania Aglaia; Gloy, Inka; Woitalla-Bruning, Jasmin

doi:10.1055/a-1171-5032

Cited by 3 publications

(1 citation statement)

References 14 publications

(21 reference statements)

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“…Now a days most phlebological procedures are performed with this type of anaesthetic and the use of tumescent in phlebological procedures is well known [24]. Hypersensitivity to local anaesthetics in general is often suggested, but seldom proved, although recently a type IV reaction on prilocaine was described [25,26,27]. Hypersensitivity to TLA can be caused both by the anaesthesia itself, as by the preservatives (paraaminobenzoic acid or PABA).…”

Section: Tumescent Anaesthesia (Tla)mentioning

confidence: 99%

Allergies in Phlebology: A National Survey and Review of Literature

Visch

Roos²

2022

Phlebologie

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Background Type I and type IV hypersensitivity can play an important role in phlebology with potential severe consequences for patients and treatment results. Methods A review of literature was performed for allergic reactions in patients treated for venous insufficiency and venous leg ulcers (VLU), together with a study in the Dutch and European centre for adverse drug reactions. Besides, we performed a survey among 37 Dutch medical hospitals to investigate the incidence of treatment allergies. Results Hypersensitivity reaction is seen in 46–76% of patient with VLU; about 20% of these reactions are caused by wound dressings products. In 11 centres urticarial and respiratory complaints were seen and 3 systemic allergic reactions in phlebological treatments. In Europe 25 cases of systemic reactions were reported. Conclusion Patients with VLU with slow healing tendency should undergo allergy tests. Type I hypersensitivity with anaphylactic reaction, also to sclerosing fluid or tumescent, is very rare.

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Section: Tumescent Anaesthesia (Tla)mentioning

confidence: 99%

Allergies in Phlebology: A National Survey and Review of Literature

Visch

Roos²

2022

Phlebologie

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Prilocaine

2021

Reactions Weekly

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Contact dermatitis : case reportA 46-year-old woman developed contact dermatitis following treatment with prilocaine for local anaesthesia [route, dosage, duration of treatment to reaction and outcomes not stated].The woman, who had grade III Hach vena saphena magna insufficiency with dependent lateral branch varicose on the right leg. A few years previously, she had undergone a hallux valgus surgery under local anaesthesia. Several days later, she developed blisters on the sole. It was classified as allergic reaction. Later, she underwent surgical remediation of the varicose. She underwent surgery under unspecified general and local anaesthetics of TLA solution including prilocaine 0.069%, epinephrine, sodium bicarbonate, in addition to sodium chloride with Metyhl-4-Hydroxybenzoat (1200mL solution corresponds to 825mg prilocaine) was infiltrated SC along the varices to be removed. Later, she received infection prophylaxis with cefazolin. After completion of the surgery a padded short-draw compression bandage was applied from the metacarpophalangeal joint to the groin. From second postoperative day compression therapy was started. Post operative course was unremarkable. She was discharged completely. She was hospitalised on postoperative day 5 due to an itchy redness in the area of the right leg (appeared on postoperative day 2). Over the course her additional occurrence of blisters and blisters. On admission, there was a pronounced, sharply defined, acute erythema on the right medial thigh extending from the inguinal below the knee (area of the pulling channel of the great saphenous vein), it was weeping, itching and painful with confluent vesicles and blisters. It was considered as type IV allergic reaction in the form of delayed allergic contact dermatitis.The woman was then treated with methylprednisolone, pantoprazole along with unspecified steroids. She also received paracetamol for analgesia, along with ampicillin/sulbactam as prophylaxis for bacterial infection, nadroparin calcium for thrombolysis prophylaxis. After 3 days of therapy and hospitalisation, she showed a significant improvement and discharged. Laboratory work up was unremarkable.

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Folgenreiche Liposuktion – was man im Umgang mit Prilocain beachten sollte

Mayer

Capellen

Holzbach

2021

Handchir Mikrochir Plast Chir.

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ZusammenfassungUnter der selten auftretenden erworbenen Methämoglobinämie ist die Prilocain-induzierte ätiologisch gesehen eine Rarität. Der folgende Fallbericht behandelt sie als potenziell gefährliche Komplikation nach Liposuktion mit Prilocain.Eine junge Patientin stellte sich nach präsynkopalem Sturzereignis mit blassem Hautkolorit, immobilisierendem Handgelenksschmerz und Platzwunde am Kinn in der interdisziplinären Notaufnahme vor. Etwa 12 Stunden zuvor sei bei der Patientin ambulant in Regionalanästhesie eine Liposuktion der unteren Extremität durchgeführt worden. Dabei sei ein größeres Volumen einer Tumeszenzlösung, bestehend u. a. aus Prilocain, in das Gewebe infiltriert worden.Bei initialer Vorstellung wurden ein normwertiger Blutdruck, eine leichte Tachykardie, eine periphere Sauerstoffsättigung von 90 % bei Raumluft gemessen und klinisch fielen ein reduzierter Allgemeinzustand und eine Lippenzyanose auf. Die Liposuktionszonen waren unauffällig.Die erste arterielle Blutgasanalyse zeigte einen erhöhten Methämoglobin(Met-Hb)anteil von 10,9 %. Konventionell-radiologisch ließ sich eine minimal dislozierte distale Radiusfraktur nachweisen. Unter Sauerstofftherapie fiel das Met-Hb innerhalb von 4 Stunden auf 6 %, die Lippenzyanose war rückläufig, die Vitalparameter stabilisierten sich, die Platzwunde wurde mittels primärer Wundnaht versorgt und es erfolgte eine Ruhigstellung des Handgelenks. Nach 12-stündigem Aufenthalt erfolgte die Entlassung bei gebessertem Allgemeinzustand. Sechs Wochen posttraumatisch zeigte sich eine Konsolidierung der Fraktur und funktionell-ästhetisch regelrechte Wundheilung des Kinns. Wir möchten für die Differenzialdiagnose einer Prilocain-induzierten Methämoglobinämie nach Liposuktion mit Tumeszenzlösung sensibilisieren und im Allgemeinen die Verwendung von Prilocain diskutieren.

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Allergische Reaktion vom Typ IV auf Prilocain nach Anwendung von Tumeszenz-Lokalanästhesie – eine seltene Komplikation

Cited by 3 publications

References 14 publications

Allergies in Phlebology: A National Survey and Review of Literature

Allergies in Phlebology: A National Survey and Review of Literature

Prilocaine

Folgenreiche Liposuktion – was man im Umgang mit Prilocain beachten sollte

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