Safety of local anesthetics<sup>,</sup>

Cherobin, Ana Carolina Figueiredo Pereira; Tavares, Glaysson Tassara

doi:10.1016/j.abd.2019.09.025

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Review • An. Bras. Dermatol. 95 (1) • Jan-Feb 2020 • https://doi.org/10.1016/j.abd.2019.09.025 copy

Safety of local anesthetics^☆ ☆ How to cite this article: Cherobin ACFP, Tavares GT. Safety of local anesthetics. An Bras Dermatol. 2020;95:82-90. ^,^☆☆ ☆☆ Study conducted at the Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Abstract

Local anesthetics are essential medications for the conduction of dermatological procedures. They stop the depolarization of nerve fibers and are divided into two main categories, the amide and ester types. Systemic toxicity with reflex on the central nervous and cardiovascular systems is their most feared adverse reactions, and the anaphylactic reaction is the most concerning one. Although potentially fatal, these events are extremely rare, so local anesthetics are considered safe for use in in-office procedures.

KEYWORDS
Anaphylaxis; Anesthetics, local; Drug-related side effects and adverse reactions

Anesthetic	Protein affinity	Onset of action	Duration without epinephrine (min)	Duration with epinephrine (min)
Amide type
Lidocaine	64	2-3 min	30-120	60-400
Mepivacaine	77	3-20 min	30-120	60-400
Bupivacaine	95	5-8 min	120-240	240-480
Ester type
Procaine	5.8	5 min	15-30	30-90

Anesthetic	Adult dosing (without epinephrine)	Adult dosing (with epinephrine)	Pediatric dosing (without epinephrine)	Pediatric dosing (with epinephrine)	Category in pregnancy
Amide type
Lidocaine	4.5 mg/kg (max: 300-350)	<7 mg/kg (300-500)	4.5 mg/kg (300)	<12 years old: 4.5 mg/kg (100-150)	B
Lidocaine	4.5 mg/kg (max: 300-350)	<7 mg/kg (300-500)	4.5 mg/kg (300)	>12 years old: <7 mg/kg (300-500)	B
Mepivacaine	<300 mg	<500 mg	4-6 mg/kg (270)		C
Bupivacaine	2 mg/kg or 175 mg (single dose) or 400 mg/24 h (total dose)	225 mg	Safety and efficacy have not been established	Safety and efficacy have not been established	C
Ropivacaine	2.9 mg/kg (200 mg)		Safety and efficacy have not been established	Safety and efficacy have not been established	B
Ester type	2.9 mg/kg (200 mg)		Safety and efficacy have not been established	Safety and efficacy have not been established	B
Procaine	350-500 mg	600 mg	<15 mg/kg		C

Age and body weight requirement	Maximum total dose (g)	Maximum application area (cm²)	Maximum application time (hours)
0-3 months or <5 kg	1	10	1
3-12 months and >5 kg	2	20	4
1-6 years old and >10 kg	10	100	4
7-12 years old and >20 kg	20	200	4

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E-mail: revista@sbd.org.br

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[1] * Corresponding author. E-mail:anacherobin@yahoo.com.br (A.C.F.P. Cherobin).

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Safety of local anesthetics☆ ☆ How to cite this article: Cherobin ACFP, Tavares GT. Safety of local anesthetics. An Bras Dermatol. 2020;95:82-90. ,☆☆ ☆☆ Study conducted at the Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Abstract