An Unusual Complication with Use of Lignocaine: A Case Report

Abstract

A 50-year-old male reported to the Department of Oral & Maxillofacial Surgery of Chhattisgarh dental college & research institute, Rajnadgaon for removal of a carious tooth in lower right region of the jaw. As a part of general protocol a detailed case history was taken prior to the procedure and skin testing for allergy was planned prior to the extraction. The patient's past medical history was unremarkable. The patient was informed of the possible complications and a written consent was taken. A test dose of 2% plain lignocaine HCL from a multidose vial was deposited intradermally to produce a 5-mm diameter wheal [Table /Fig-1a]; the area was marked. Blood pressure and vital signs were monitored closely after intradermal injection. Within a time period of five min after injection patient started showing symptoms of drug allergy. Initially there was localized erythema at the site of the injection.Within few minutes patient started complaining of itching over different body parts, the patient was apprehensive, anxious and started showing generalized skin reaction, he had multiple solid raised lesions or papules less than 1 cm in size, flat topped, on his neck, trunk and limbs [Table/ Fig-2a&b]. Symptoms were resolved within one hour following treatment with antihistamine (Pheniramine maleate 25mg i.v.) and corticosteroid (dexamethasone 8mg i.v.). Later the extraction was performed using 0.5% bupivacaine after negative result of the skin testing with the same. Allergic responses to lignocaine (amide local anaesthesia) used in dentistry is extremely rare. It is widely used by Oral Maxillofacial surgeons to carry out various procedures safely, comfortably and efficiently. It is important for the practitioners to be aware that allergic reactions though very rare, can occur after injection of lignocaine intradermally for allergy testing. A proper diagnosis and management of such allergic reaction is very essential to avoid undesired consequences. We report a case of a 50-year-old male who suffered itching and generalized skin reaction within 5 minutes after administration of test dose of lignocaine intradermally for allergy testing. Clinical presentation, Diagnosis & management of such allergic reaction are discussed. As local anaesthetic agents are commonly used drugs in day to day practice clinicians are encouraged to be familiar with the presentation of various allergic reactions and there management. DisCussionLignocaine was first introduced into the practice in 1946 [1] since then it has been used very commonly in routine clinical practice. Local anaesthetics are divided into two groups: (i) amide derivatives of xylidine and toluidine group (lignocaine, mepivacaine, prilocaine) and (ii) ester or benzoic and aminobenzoic derivatives (cocaine, benzocaine, procaine, tetracaine, butacaine).The allergic reactions to the lignocaine is extremely rare, it has been estimated that true allergic reactions to local anaesthetics account for less than 1% of all adverse reactions to local anaesthetics [2,3]. Only a few cases ...

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