What Is it About Lidocaine?
A Bruno Byte “Tidbit”
Question:
I've had several issues with local anesthetics. I have post-herpetic neuralgia that caused swelling and pain in my face and was given Lidocaine gel. The swelling and pain increased and I stopped the gel.
Then I was given a Lidocaine (with epinephrine) injection for out of control spasms in my upper back and neck. That time I had severe pain and a feeling like my heart was racing. Because of this my physician told me to be wary of any of local anesthetics.
When I had a cavity a few years later, I told the dentist about my problem with Lidocaine he gave me 3% Mepivicaine (without epinephrine) and I did fine.
Is there an issue with Lidocaine in polio survivors?
Answer:
Lidocaine (xylocaine) can be very irritating on top of or underneath the skin. This is not a polio survivor issue but something that polio survivors should be aware of because doctors typically use the commonly available and inexpensive 1% Lidocaine rather than other more potent local anesthetics. Since polio survivors are twice as sensitive to pain as everyone else, they will need more 1% Lidocaine than they would 2% Marcaine (or 3% Mepivicaine for dental procedures).
One example: a Post-Polio Institute patient needed to have a wound closed. The doctor had to use six times the amount of 1% Lidocaine than was indicated and the patient still felt pain. The doctor switched to a normal dose of Marcaine and the patient had almost immediate anesthesia.
Also, “more Lidocaine” is a problem because injectable local anesthetics usually contain epinephrine, which constricts blood vessels so the anesthetic doesn't travel beyond the injection site. Unfortunately patients sometimes have adverse reactions - rapid heart rate, panic attacks - to the epinephrine. So let your dentist or doctor know about any issues you have with local anesthetics.
For much more information, see Preventing Complications in Polio Survivors Undergoing Dental Procedures, under the topic of “Anesthesia” in the comprehensive Encyclopedia of Polio & PPS.
The Encyclopedia of Polio and Post-Polio Sequelae contains all of Dr. Richard Bruno’s articles, monographs, commentaries, videos and “Bruno Bytes” (Q & A articles).
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