Precautions Related to the Administration of LAs

Drugs seldom exert their beneficial effects without also causing adverse drug reactions (ADRs). In addition to overdose, ADRs may be caused by therapeutic doses of drugs because of drug-drug, drug-food, drug-herbal, and drug-disease interaction-related to pharmacokinetic or pharmacodynamic processes. Drugs or their metabolites may also be inherently toxic and produce cytotoxic reactions. Other LA-related ADRs may be immune mediated or are idiosyncratic.14,18-25,27-29

ADRs associated with the administration to lidocaine, mepivacaine, prilocaine, articaine, and bupivacaine, in general, are similar and may be consider together.14,18-25 However, some LAs with unique toxicities will be highlighted. For example, prilocaine is more likely to induce methemoglobinemia in susceptible patients;23 prilocaine and articaine are more likely to produce paresthesia following mandibular nerve blocks;49-51 and bupivacaine is the most cardiotoxic.14,18-25