Preservatives in Local Anesthetic Solutions

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Preservatives in local anesthetic solutions

Beth L. Ladlie, MD, MPH

Although allergies to local anesthetic agents are rare, they do exist, and allergic reactions to aminoester local anesthetic agents are more common than are reactions to aminoamide local anesthetic agents. Regardless of the subclass of the agent, local anesthetic preparations often contain additives that are intended to prolong their shelf life. Some adverse reactions after administration of local anesthetic agents may be caused by these additives (Table 118-1).

Table 118-1

Function and Possible Toxicity of Preservatives Used in Local Anesthetic Agents

Preservative Class	Function	Possible Toxicity
Sulfites	Antioxidant	Anaphylactoid reactionArachnoiditis
EDTA	Chelating agent	Low back pain at epidural injection site
Methylparaben	Antimicrobial	Anaphylactoid reaction

EDTA, Disodium ethylenediaminetetraacetate.

Sulfites

Sulfites are antioxidants used to stabilize vasoconstricting agents (e.g. epinephrine) that are often added to local anesthetic solutions. Common sulfites include bisulfite and metabisulfite. Sulfites are capable of inducing anaphylactoid reactions, which can include angioedema, urticaria, seizures, bronchospasm, and even death. Sulfites are present as preservatives in foods and beverages, so patients will likely have had multiple exposures to sulfites prior to receiving a local anesthetic solution that contains a sulfite.

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