Suspected Lignocaine Allergy: Safe Conduct of Spinal Anesthesia with Bupivacaine.
Aparna Bagle, Abhishek Raj, Amala Kale
✦ AI-curated · Sources linked
Case in brief
A 69-year-old man with chronic obstructive pulmonary disease and suspected lignocaine allergy was scheduled for transurethral resection of the prostate. Intradermal testing was positive for lignocaine and negative for preservative-free heavy bupivacaine. Spinal anesthesia using heavy bupivacaine and fentanyl was selected, with prophylactic corticosteroids and antihistamines. The operation proceeded uneventfully.
What made this case unusual
Testing showed different intradermal responses to the suspected allergen and the alternative local anesthetic, allowing spinal anesthesia to proceed with bupivacaine.
Diagnostic / clinical pearl
When local-anesthetic hypersensitivity is suspected, intradermal testing with the intended alternative agent can help guide anesthetic selection; interpret results individually and remain prepared for reactions.