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Alternatives to lidocaine - a patient who needs local anesthesia but is allergic to Lidocaine and all the other "caines". Is Diphenhydramine hydrochloride is a good alternative. Anyone have any experience with it? Any other suggestions?


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CFG

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Canada Foot Guy

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Hi

Diphenhydramine HCl ia an antihistamine and has no anaesthetic properties/uses.

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Dharmendra (Drummond) Goven

From my quick look at the research it seems that Diphenhydramine is a viable alternative local anesthetic to Lidocaine for patients who are allergic to “Caines”(Bartfield, Jandreau, & Raccio-Robak, 1998; Bartfield, May-Wheeling, Raccio-Robak, & Lai, 2001; Ernst et al., 1994)

Dire & Hogan state “The duration of local anesthesia for 1% lidocaine was significantly longer and the depth of anesthesia after 30 minutes was significantly higher than that of 1% diphenhydramine. And Diphenhydramine resulted in skin necrosis in one test subject ”.

You may also want to take a look at Benzyl alcohol (BA) with epinephrine as an alternative, as a couple of studies show that BA is superior to diphenhydramine.(Bartfield et al., 2001)
According to Bartfield, Jandreau, & Raccio-Robak (1998) Benzyl alcohol is a better alternative than diphenhydramine as a local anesthetic for lidocaine-allergic patients.(Bartfield et al., 1998)

Have a read of the studies below,

Hope that helps



Refferences

Bartfield, J. M., Jandreau, S. W., & Raccio-Robak, N. (1998). Randomized Trial of Diphenhydramine Versus Benzyl Alcohol With Epinephrine as an Alternative to Lidocaine Local Anesthesia. Annals of Emergency Medicine, 32(6), 650-654. doi: 10.1016/s0196-0644(98)70062-9

Bartfield, J. M., May-Wheeling, H. E., Raccio-Robak, N., & Lai, S.-Y. (2001). Benzyl alcohol with epinephrine as an alternative to lidocaine with epinephrine. The Journal of Emergency Medicine, 21(4), 375-379. doi: 10.1016/s0736-4679(01)00404-8

Dire, D. J., & Hogan, D. E. (1993). Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Annals of Emergency Medicine, 22(9), 1419-1422.

Ernst, A. A., Marvez-Valls, E., Mall, G., Patterson, J., Xie†, X., & Weiss, S. J. (1994). 1% Lidocaine Versus 0.5% Diphenhydramine for Local Anesthesia in Minor Laceration Repair. Annals of Emergency Medicine, 23(6), 1328-1332. doi: 10.1016/s0196-0644(94)70360-4

THANKS !!!! very helpful

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Canada Foot Guy

I'd take .25cc of xylocaine and raise a wheel and see if you get a local reaction.
I would be extremely surprised if your patient has a true allergy to xylocaine.

Steve

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DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

I wonder if any members have tried using acupuncture for this?

Pregunto si aplicando lidocaina al 2 % en onicocriptosis con inflamación y infección puede crear
inconveniente posteriores. Hasta el presente lo realizo sin tener resultados negativos.

From what I have read, there are allergies to preservatives and adrenaline, and perhaps some of the LA's, but I have never heard of anyone or seen any literature showing allergies to all local anaesthetics ending in 'cain. Isnt the 'cain suffix just historical from the original use of cocaine as a LA? Are all LA's derived from the chemical structure of cocaine? (showing my ignorance now) . I would test a small area with Ropivacaine (without adrenaline) , this reputedly has low toxicity, and may be different enough in chemical structure to fool this persons immune system. Please let us know how you get on

True allergy to lidocaine is very rare but true allergy to all of the local anaesthetics ending in'caine' ( isn't that all of the local anaesthetic?) must be many times rarer than hens' teeth? Possibly he is allergic to the suffix 'caine'?

It seems to me that the most important thing for this man is that he is comprehensively tested for allergy to the local anaesthetic agents and the additives.

Otherwise, if he doesn't have a true allergy to any or even all (approaching miracle status), he is going to limit his life severely, making even the slightest surgical procedure a drama and a crisis both for himself and for the surgeon.

Bill