Abstract
Local anesthetics are among the most commonly used drugs in pain clinics. Although an allergic response to a local anesthetic is remarkably rare, local anesthetics are capable of causing true allergic reactions. However, delaying the initiation of treatment may cause death. The mechanism and pathophysiology of anaphylaxes are reviewed, and treatment based on them is discussed. Allergic reactions to local anesthetics are mainly allergic contact dermatitis (about 80%); on the contrary, the frequency of anaphylaxes is around 1%. The first-line drugs are oxygen, fluid, and adrenaline. Identification of the causative drug is necessary when anaphylaxis occurs. Clinical course after the initiation of anaphylaxis is so rapid that appropriate treatment should be necessary to prevent severe damage or death. Rapid recognition and treatment of such reactions can prevent much of the morbidity and mortality that would otherwise occur. For these reasons, a pain clinician should be familiar with treatment of anaphylaxes.
