Adverse drug reactions to local anesthetics: a systematic review

Objective: The aim of this study was to analyze adverse drug reactions (ADRs) associated with local anesthetics (LAs) and to characterize the safety profile of LAs in clinical application.

Study design: Electronic databases were searched, and the data of the included articles were extracted and analyzed.

Results: A total of 922 articles were retrieved, and 101 of them, containing 1,645 events, were included. Lidocaine (43.17%) and bupivacaine (16.32%) were the most often involved LAs. Epinephrine (45.37%) was mostly combined with LAs. Cardiovascular system reactions (27.83%) were the most involved systematic ADRs of LAs. Among 7 death events (3.54%), 2 patients died of intravascular injection. According to the meta-analysis, the risk of using LA alone was lower than combined with epinephrine.

Conclusions: The present study demonstrated that the ADRs of LAs could not be ignored, especially in oral and ophthalmologic treatments. Some ADRs could be avoided by properly evaluating the conditions of patients and correctly applying LAs.