Presentation and Management of Local Anesthetic Hypersensitivty in Ukraine

[Adverse drug reactions of local anesthetics used in dentistry]

The aim. Study the adverse drug reactions (ADR) that occur when using local anesthetics (LA) in patients living in the Republic of Crimea and registered during the period 2010-2018.

MATERIAL AND METHODS

The objects of the study were 122 notification forms about LA ADR recorded in the regional base (Register) of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). In most cases, ADR was associated with the use of amide LA Lidocaine - 69 cases (56.55% of the total number of cases for LA ADR), less often, ADR was caused by combinations containing Articaine (34 cases, 27.87%). Rare cases of ADR were reported for Novocaine/Procaine (9 cases, 7.38%), Bupivacaine (8 cases, 6.56%) and Mepivacaine (2 cases, 1.64%). The main clinical manifestations of reactions were hypersensitivity-like reactions (38 cases), cardiac and vascular disorders (29 cases) and central nervous system disorders (19 cases). Lack of effectiveness of LA occurred in 13 cases (10.66%).

RESULTS

A study of the outcome of ADR revealed a high incidence of life-threatening conditions associated with LA use - 31 cases (25.4%), which indicates the severity of the event and the need to cancel the suspected drug and prescribe additional medications for correction. The need for hospitalization or prolongation of hospitalization was necessary in 7 cases (5.8%), and temporary disability of patients was revealed in 5 cases (4.1%). Of particular interest are 2 cases (1.6%) of the development of a fatal outcome as a result of the suspected anaphylactic shock (1 case) and disorders of the central nervous system (convulsions, development of respiratory failure).

CONCLUSION

The high frequency and severity of unwanted effects resulted from the use of LA requires healthcare professionals to make rational choices and strictly monitor patient safety.

[Dental care for patients at risk of adverse reaction to local anesthetics]

The study comprised 53 patients with side effect history to local anesthetics. The reasons for the occurrence of adverse reactions to local anesthetics was analyzed, and the frequency of their occurrence in dental practice was studied. It was found that in most patients (85%) with 'allergic reactions' to local anesthetics the diagnosis was unreasonable and incompetent. In most cases psychosomatic reactions were mistaken for an immediate allergic reaction. The prevalence of adverse reactions to local anesthetics was 1 case per 448 injections (1:448), true allergic reactions was documented in 0.1% cases.