Although it is possible to do intradermal or subcutaneous provocative testing for suspected local anesthetic toxicity, it is more practical and prudent to select an amide local anesthetic for administration to the patient suspected of allergy to an ester. The reverse of this recommendation would also be true. Use a preservative-free preparation of the 'safe' local anesthetic. An alternative approach for minor procedures is to use diphenhydramine as a local anesthetic, as it is chemically unrelated to the 'caines'. However, diphenhydramine is not as potent as other local anesthetics. Confirming the safety of a local anesthetic using an in vivo challenge test or in vitro diagnostic test is necessary only when failure to do so would prevent the use of local anesthesia. Table 5 summarizes the clinical application of subcutaneous provocative dose testing in this setting. The interventional radiologist involved in the patient's care should be knowledgeable about evaluation and prophylaxis of drug allergies and should also be capable of giving initial treatment for any life-threatening reaction that occurs.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine