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The negative predictive value of typing safe local anesthetics
Krzysztof Specjalski1, Karolina Kita-Milczarska, Ewa Jassem
1Department of Allergology, Medical University of Gdansk, Gdansk, Poland.
International Archives of Allergy and Immunology
|July 3, 2013
Summary
Identifying a safe local anesthetic (LA) through stepwise allergy testing is highly effective. This method accurately predicts safe anesthetic options for patients with a history of adverse LA reactions, achieving a 97% negative predictive value.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Dermatology
Background:
- Adverse reactions to local anesthetics (LA) are frequently reported, despite the rarity of true allergy.
- Patients with a history of anaphylaxis or unusual reactions to LA require safe anesthetic identification for future procedures.
Purpose of the Study:
- To determine the negative predictive value (NPV) of a stepwise protocol for identifying safe local anesthetics.
- To evaluate the safety and efficacy of allergy testing for LA in patients with a history of adverse reactions.
Main Methods:
- A total of 154 patients with a history of adverse LA reactions were enrolled.
- Stepwise allergy typing involved skin prick tests (SPT), intracutaneous tests (ICT), and drug provocations with common LAs (lidocaine, bupivacaine, mepivacaine, articaine).
- A 4-12 month telephone follow-up assessed patient outcomes after administration of the typed safe anesthetic.
Main Results:
- The complete protocol was performed in 148 patients.
- Positive skin tests (SPT/ICT) and provocations were observed in 2, 19, and 11 patients, respectively.
- The protocol demonstrated a high negative predictive value (NPV) of 97% for identifying safe LAs, with 76 out of 78 patients reporting no adverse reactions.
Conclusions:
- A stepwise approach incorporating SPT, ICT, and provocations is a safe and effective method for identifying safe local anesthetics.
- This protocol successfully identifies a safe anesthetic for the vast majority of patients with a history of adverse reactions to LA.
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