Skin Necrosis Caused by Prilocaine: A Case Report

Selcuk Aytac, MD; Abdullah Etöz, MD; Selcuk Akin, MD

Disclosures

Wounds. 2005;17(3):58-61. 

In This Article

Abstract and Introduction

Prilocaine (CitanestTM, AstraZeneca Pharmaceuticals, Wilmington, Del) is a commonly used agent in infiltrative anesthesia, and its adverse effects are well known. The authors report a full-thickness skin necrosis after using prilocaine as a local anesthetic that resulted in a flap closure. To the authors' knowledge, there have been no previously described cases of skin necrosis after use of the local anesthetic prilocaine. Possible adverse reactions to preservatives that are added to local anesthetics in pharmaceutical preparations may play a role in skin necrosis secondary to prilocaine usage. Multifactorial adverse effects may cause unexpected reactions with the use of prilocaine, a safe and frequently used pharmaceutical.

Local anesthetics are divided into 2 main groups based on their chemical structure: amides and esters. Prilocaine (CitanestTM, AstraZeneca Pharmaceuticals, Wilmington, Del) is a commonly used agent in infiltrative anesthesia, and its adverse effects are well known. It has been the least toxic of the presently used agents containing an aromatic benzene ring in their molecules.[1,2]

Adverse reactions from the amide group of local anesthetics are rare.[3] Adverse reactions include toxic, psychosomatic, idiosyncratic, and allergic-pseudoallergic reactions. The likelihood of these reactions appears to depend on the dosage, the surface area of application, the condition of the skin, and the systemic hepatic, renal, or cardiac functions.[4] Local reactions include the development of erythema, pallor, and edema. Amide anesthetics may also provoke other reactions, such as swelling, ulceration, nausea, and drug eruptions.[3] Immunoglobulin E-mediated allergic reactions, such as urticaria, angioedema, bronchial spasm, and anaphylactic shock, are uncommon.[4,5] There is a delayed type of allergic reaction with local anesthetics characterized by swelling within 2 to 24 hours, which lasts for several days.[4]

Prilocaine is rapidly metabolized by the liver and kidneys.[6] Allergic reactions may be caused by the anesthetic, a metabolite, a preservative, or an unrelated substance.[4]

The authors present a case of skin necrosis after the use of prilocaine as an infiltrative anesthetic, which has not been reported previously.

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