Reactions to Local Anaesthetics =============================== þ "Allergic Reactions" usually _not_ true allergy. - In one study, 90 patients who claimed allergy had no evidence for immediate hypersensitivity. (In some cases, alternative anesthetics were tested.) [DeShazo R, Nelson H. An approach to the patient with a history of local anesthetic hypersensitivity: experience with 90 patients. J Allergy Clin Immunol 1989;63(6):387.](check date; might be 1979) þ Procaine reaction - acute psychosis from the procaine in procaine penicillin injections (as previously much used for GC, not the benzathine PCN still used for strep throat single-injection treatment). [Silber TS, D'Angelo L. Psychosis and seizure following the injection of penicillin G procaine. AJDC 1985;139:335.] þ Ischaemic Damage from Epinephrine Injection - Not reported from lido+epi (1:100,000) - podiatrists use lido+epi routinely for toes "My father has been a Podiatrist for over 30 years. He estimates he has performed over 20,000 digital blocks. He has always used Lido with Epi:Lido without Epi in a 1:3 mixture. He states he gets less blood in the field and a longer length of anasthesia with the Epi. He does not use Epi on patients with poor circulation or very small digits (less collateral circulation). He has never encountered a complication in over thirty years with this approach. I find this to be more telling than two studies, one of which is thirty years old and one of which is based on a rat model!" --Daniel E. Kates, M.D. dkates@primenet.com Thunderbird Samaritan Medical Center Phoenix, Arizona - Reported from 1:1000 injection [Hardy SJ, Agostini DE. Accidental epinephrine auto-injector-induced digital ischemia reversed by phentolamine digital block. J Am Osteopath Assoc 1995 Jun;95(6):377-8.] Abstract: