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Are there adverse drug reactions to local anesthetics?

This summary is based on the article published in the Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology journal: Adverse drug reactions to local anesthetics: a systematic review (March 2013)


Local anesthetics (LAs) are widely used, especially in oral and ophthalmologic treatments.

The types, doses, means of administration of LAs, and combined drugs are the main factors that could induce adverse drug reactions.

Purpose of the Review

Analyze adverse drug reactions (ADRs) associated with local anesthetics (LAs) and to characterize the safety profile of LAs in clinical application.


  • A total of 922 articles were retrieved, and 101 of them, containing 1,645 events, were included.
  • Lidocaine and bupivacaine were the most often involved LAs. Epinephrine was mostly combined with LAs.
  • Cardiovascular system reactions were the most involved systematic ADRs of LAs. Among 7 death events, 2 patients died of intravascular injection.
  • According to the meta-analysis, the risk of using LA alone was lower than combined with epinephrine.

Key Messages 

  • The ADRs of LAs could not be ignored, especially in oral and ophthalmologic treatments.
  • Cardiovascular system reaction is no longer rare as it was once thought and cardiac arrest is the most life-threatening ADR of LAs.
  • Clinicians should improve their awareness of LA dosage, concentration, and combination of drugs. As well,  it is imperative to adequately appraise the patient’s health, psychological, and allergy conditions before administering LA. 
  • Some ADRs could be avoided by properly evaluating the conditions of patients and correctly applying LAs.



Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

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  1. Howard September 6, 2013

    Thank you for this fantastic article!

  2. Howard Stein September 11, 2013

    What are the safe dosage limits for xylocaine and epinephrine use for the various age and weight groups that we should consider when requiring multiple injections during the same appointment?


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