Management of a Parturient with a History of Local Anesthetic Allergy

Abstract

The management of parturients with a strong history of allergy to local anesthetics poses significant challenges to the obstetric anesthesiologist. We recommend that when such patients have a strong desire to receive labor analgesia with local anesthetics, they undergo provocative challenge testing with preservative-free bupivacaine performed in labor and delivery with preparations for emergent cesarean delivery after 24-wk gestation.

Anesthésie ďune parturiente en travail, atteinte ďurticaire pigmentaire

“…Second, since lidocaine has been used successfully in the past for labour analgesia, 9 it was reasonable to agree to use it as an infusion for labour pain. Finally, even though allergy testing is possible, and sometimes recommended, during pregnancy and labour, 10,11 it is still somewhat controversial, 12,13 especially if another agent is known to be safe for the patient. In the consultation, we also suggested avoiding medications that release histamine such as morphine and meperidine.…”

Allergies to local anesthetics — the real truth

“…Balestrieri et al 15 recently published a report of how they handled a case of suspected "caine" allergy in an obstetric patient. They performed provocative testing in this patient at 38 weeks gestation.…”

What’s new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature

“…33 Sensitivity testing may not be valid during pregnancy and also introduces the risk of fetal sensitization, 34 so it is not recommended by the American Academy of Allergy, Asthma and Immunology. 35 The potential for altered drug responses during pregnancy is highlighted in a thoughtful review by Pleym et al 36 who observed that non-pregnant women have a 20-30% greater sensitivity to muscle relaxants, a 30-40% greater sensitivity to opioid receptor agonists and a 30-40% lesser sensitivity to propofol.…”