Background and Aims Genuine allergic reactions to amide local anaesthetics are extremely rare. When a 32 year old parturient with Local Anaesthetic (LA) Allergy presented to the Obstetric Anaesthetic Clinic, further investigation into the allergy was required. This lady, with a background of Charcot-Marie- Tooth disease, was told to avoid all LA’s after collapsing during a dental procedure as a child. During her first pregnancy in another hospital, she was told she would not receive any LA and had Entonox for labour analgesia and was given General Anaesthesia (GA) for a perineal tear repair. Following this experience she developed Post Traumatic Stress Disorder. She subsequently requested a caesarean under GA for this pregnancy. We referred her to the Allergy Clinic for a conclusive diagnosis.
Methods The 38 week parturient was admitted to Labour Suite and under the advice of the Allergy Clinic, we performed subcutaneous challenge testing of Lidocaine and Levobupivacaine. We consented her for the testing, risk of anaphylaxis and early delivery of the baby including emergency caesarean section, and ensured all emergency drugs and equipment were available. We monitored Pulse, Blood Pressure, Peak Expiratory Flow Rate, and Cardiotocography. Increasing doses of Lidocaine were given incrementally at 20 minute intervals. Between each step, we observed the patient for signs of haemodynamic instability and local allergy. We waited one hour before testing the Levobupivacaine in the same way.
Results The lady did not develop any allergic reactions and can now have LA in future.
Conclusions LA allergy testing at term pregnancy can safely identify true LA allergy.
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