Local anaesthetic use is widespread in dentistry and while lidocaine has been in use for more than 50 years an increasing number of agents are now available. The aim of this study was to analyze adverse drug reactions (ADRs) associated with local anesthetics (LAs) and to characterize the safety profile of LAs in clinical application.

The Medline, Embase, Chinese National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Chinese Biomedical Literature Databases were searched.  A wide range of study designs (randomized controlled trials [RCTs], non-RCTs, case-control studies, case reports, case series, and cross-sectional studies) reporting ADRs of LAs were included.  Two reviewers conducted study selection and data abstraction independently with a third resolving differences.

101 studies (81 case reports, 21 clinical trials) were included, reporting 1645 ADRs.

• The most commonly reported age group was 60-69 years (23.28%)
• Lidocaine (43.17%) and bupivacaine (16.32%) were the most often involved LAs.
• Cardiovascular system reactions (27.83%) were the most involved systematic ADRs of LAs. Among 7 death events (3.54%), 2 patients died of intravascular injection.
• According to the meta-analysis, the risk of using LA alone was lower than combined with epinephrine. The pooled incidence ADRs of
  • LA with epinephrine was 0.02 (95% CI 0.02- 0.03) and
  • LA alone was 0.01 (95% CI 0.01-0.01).
• indirect comparison showed that the number of ADRs related to LA with epinephrine is 2.16 times than that of LA alone (RR 2.16, 95% CI 1.50-3.11).

The authors concluded

The present study demonstrated that the ADRs of LAs could not be ignored, especially in oral and ophthalmologic treatments. Some ADRs could be avoided by properly evaluating the conditions of patients and correctly applying LAs.

Comment

This is an interesting review with the included studies ranging from 1967-2010.  As with most systematic reviews the quality of the individual studies was variable and it is to be anticipated that many of the more minor adverse events may nor have been reported by participants or collected by the original study authors. It is however encouraging to note that there was more reporting in the later literature.  While lidocaine and bupivacaine had the greatest number of ADRs they have been in use for the longest period.  The discussion also highlights the fact that good good history taking and clinical assessment of the patients may well have avoided the ADRs. The review included surface anesthesia, infiltration, and peripheral nerve blocks with the only just over 1% of the ADRs coming from surface anaesthetics which suggests that these should be considered separately.

Links

Liu W , Yang X ,Chunjie Li C, Mo A. Adverse drug reactions to local anesthetics: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012 (article in press)