A patient with a history of anaphylaxis to a local anaesthetic is being planned for wound infiltration. Which agent can be safely used because it belongs to a chemically different class from lignocaine and bupivacaine?
- A Ropivacaine
- B Chloroprocaine ✓
- C Levobupivacaine
- D Prilocaine
Correct answer: B. Chloroprocaine
Explanation
Chloroprocaine is an ester local anaesthetic, metabolised rapidly by plasma pseudocholinesterase, whereas lignocaine, bupivacaine, levobupivacaine, ropivacaine and prilocaine are all amides. True IgE mediated allergy is rare and far commoner with esters (or their metabolite para-aminobenzoic acid), so switching class is the standard advice. Chloroprocaine's very short duration limits it to short procedures, but it remains a valid alternative after amide allergy.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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