Anestacaine Side Effects
Generic Name: lidocaine
Note: This document contains side effect information about lidocaine. Some of the dosage forms listed on this page may not apply to the brand name Anestacaine.
Some side effects of Anestacaine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to lidocaine: intradermal powder
Along with its needed effects, lidocaine (the active ingredient contained in Anestacaine) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking lidocaine:More common
- Flushing, redness of the skin
- small red or purple spots on the skin
- swelling at the site of application
- unusually warm skin
- Bruising, burning, pain, or bleeding at the site of application
- itching skin
Get emergency help immediately if any of the following symptoms of overdose occur while taking lidocaine:Symptoms of overdose
- Change in consciousness
- fast, pounding, or irregular heartbeat or pulse
- loss of consciousness
- no blood pressure or pulse
- no breathing
- stopping of the heart
Some side effects of lidocaine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
For Healthcare Professionals
Applies to lidocaine: compounding powder, injectable solution
Adverse side effects of lidocaine (the active ingredient contained in Anestacaine) may be more likely and more severe in patients with liver disease.
The overall incidence of adverse side effects of lidocaine in a study of 750 patients was 6.3%. Adverse drug reactions were more common in patients with acute myocardial infarction, congestive heart failure, and liver disease. In another large study of 285 patients with suspected or documented acute myocardial infarction who received prophylactic intravenous lidocaine, more adverse events occurred in patients who received drug versus patients who received placebo. The most adverse events were recorded within the first hour of therapy in patients who eventually proved not to have myocardial infarction. Adverse events were not necessarily correlated with high lidocaine levels.
Cardiovascular side effects occur in 2% of patients. Serious cardiovascular problems include hypotension, bradycardia which may lead to cardiac arrest, and cardiopulmonary arrest. Rare cases of asystole have been reported after lidocaine (the active ingredient contained in Anestacaine) administration with and without other antiarrhythmic agents. Less commonly, negative inotropic activity, sinus node depression, torsades de pointes, and AV or His-Purkinje block have been reported.
An 84-year-old man with ischemic congestive heart failure, nonsustained ventricular tachycardia, and incomplete left bundle branch block developed sinus bradycardia, then asystole within five minutes after beginning a lidocaine 100 mg bolus and 2 mg per min infusion. Atropine was initially unsuccessful, but normal sinus rhythm resumed after approximately 20 seconds. Serum electrolytes were within normal limits at the time; arterial pO2 was not reported. A follow-up 24-hour ambulatory ECG failed to demonstrate evidence of AV heart block or bradyarrhythmias.
Toxicity is usually associated with serum lidocaine (the active ingredient contained in Anestacaine) concentrations of 9 to 10 mcg per mL, but may occur with concentrations as low as 5 mcg/mL. Central nervous system toxicity has been observed in patients with hepatic cirrhosis who were receiving lidocaine at infusion rates as low as 2.2 to 2.5 mg per min.
Transient neurologic symptoms (TNS), characterized as a symptom complex of acute onset low back pain with transient radiating pain into the buttocks and lower extremities, have been associated with the use of intrathecal hyperbaric lidocaine. TNS typically occurs within 24 hours after spinal anesthesia and resolves within 1 week without lasting sequelae. TNS has been reported in up to 40% of patients receiving intrathecal lidocaine; however, in at least two studies involving obstetric patients undergoing cesarean section or postpartum tubal ligation, the incidence of TNS did not exceed 3% following use of hyperbaric lidocaine 5%. Some practitioners consider TNS a minor manifestation of the cauda equine syndrome. It is thought that patient position may be a contributing factor to the development of TNS.
Lidocaine toxicity often presents as nervous system side effects. Yawning, restlessness, excitement, agitation, dizziness, blurred vision or double vision, muscle twitching, confusion, tinnitus, drowsiness, vertigo, paresthesias, seizures, respiratory depression and arrest, Lightheadedness, apprehension, euphoria, sensation of heat, cold or numbness, twitching, tremors, convulsions, and unconsciousness have been reported. Rare cases of seizures following topical or subcutaneous administration of lidocaine have been reported. Transient neurologic symptoms have been reported following intrathecal lidocaine.
Nausea and vomiting are common gastrointestinal symptoms of lidocaine (the active ingredient contained in Anestacaine) toxicity.
A previously healthy 27-year-old woman, pre-Cesarean section, with a history of possible hypersensitivity to bupivacaine developed tongue tingling, faintness, and nausea associated with hypotension 25 minutes after receiving bupivacaine as local anesthesia for an epidural catheter. She became progressively erythematous, pruritic, and edematous. The patient responded well to fluids, oxygen, a sympathomimetic, antihistamines, and corticosteroids. The neonate, born after emergency Cesarean section, was limp, cyanotic, edematous, and required mechanical ventilation secondary to pulmonary edema. Follow-up investigations in the mother revealed moderately raised total plasma IgE levels and positive intradermal wheal formation to 2% lidocaine (the active ingredient contained in Anestacaine)
Hypersensitivity reactions are rare. Anaphylaxis, adult respiratory distress syndrome (ARDS), and cardiovascular collapse have been associated with the use of lidocaine, and have occasionally resulted in death. Cases of angioneurotic edema, anaphylaxis, bronchospasm, and urticaria following local anesthesia with lidocaine have been reported. Contact dermatitis associated with lidocaine has been described in chemical and health care workers. Patients with a history of an allergic reaction to local amide-type anesthetics may react to lidocaine. Delayed-type hypersensitivity reactions to lidocaine have also been reported.
Psychiatric reactions have been associated with lidocaine (the active ingredient contained in Anestacaine) toxicity. Several case reports of acute psychosis associated with lidocaine infusions have been reported. It is not clear from the case reports whether these reactions were associated with therapeutic or toxic serum levels of lidocaine.
Several cases of acute and reversible psychoses have been reported in several patients, most of whom were in their sixth decade of life or older and who were receiving intravenous lidocaine.
Hematologic abnormalities associated with lidocaine (the active ingredient contained in Anestacaine) have been limited to rare reports of significant increases in methemoglobin levels during lidocaine infusions. These increases are usually not clinically significant, however, at least one case of acute topical benzocaine-induced methemoglobinemia of 29% has been reported.
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