A 46-year-old female patient, weighing 72 kg, reported to our outpatient department with the chief complaint of pain in the lower left back tooth region for 1 week. Pain was intermittent and sharp in nature. On examination, a grossly decayed 38, which was tender on percussion, was noted. Atraumatic extraction of the tooth was performed under local anesthesia using 2% lidocaine with 1:80,000 adrenaline. After 1.5 h post-operatively, the patient presented erythema and mild swelling on the left side of the face, extending from the zygomatic arch region superiorly to the mandibular inferior border inferiorly and from the corner of the mouth anteriorly to the angle of the mouth posteriorly (). The patient had mild itching with stable vitals and no other typical allergy symptoms (discomfort, choking, or loss of consciousness). Considering her clinical presentation, hypersensitivity reaction was suspected, for which 1–2.5 mg/kg steroid (hydrocortisone) was administered and tablet fexofenadine 180 mg once daily prescribed for 3 days. The erythema and itching was relieved with medication. The Department of Allergy confirmed hypersensitivity response to lidocaine, procaine, and mepivacaine.
A 54-year-old female patient, weighing 77 kg, experienced various symptoms such as clouding of consciousness, hearing impairment, and chills during dental treatment for periodontal disease using a local anesthetic. Under the assumption that these adverse effects were attributable to the use of lidocaine, the patient was transferred to the Department of Allergy to determine whether local anesthesia with bupivacaine would be possible.\nThe Department of Allergy performed skin prick and intradermal tests to test for reactivity to bupivacaine, and the patient tested negative in the skin prick test. In the skin provocation test, when administered an intradermal injection of 0.1 cc bupivacaine diluted to 1:100, the patient complained of listlessness and drowsiness beginning 30 s after the injection. Following an intradermal injection of 0.1 cc bupivacaine diluted to 1:10, the patient's symptoms of listlessness and drowsiness became more severe from 30 s after the injection. When administered an intradermal injection of 0.1 cc of undiluted bupivacaine, the patient was placed in a recumbent position on a bed owing to complaints of listlessness and heavy eyes at approximately 50 s after the injection. Subsequently, the patient showed symptoms of shivering, which eventually became uncontrollable, and she had difficulty keeping her eyes open. As a result, the patient was given 2 doses of 0.5 mg Ativan. Afterward, the patient appeared to be more stable, but began showing symptoms of shaking her chin and one of her arms, for which 0.5 ampule of Demerol™ was administered, after which her condition began to improve. The testing was completed within 20 min and the patient was discharged after a 5 h observation period. The patient was diagnosed with bupivacaine intolerance, meaning the appearance of adverse effects even with small amounts of the medication, and the dental treatment was subsequently performed under general anesthesia since local anesthesia was determined to be impossible.