Two years ago, I had some some GYN office surgery done with Lidocaine. First shot was fine, but the second one immediately gave me a feeling of a giant panic attack, racing heart, shivering, dizziness and tongue numbness and a metallic taste in the mouth. It lasted a half hour or more. Very scary! After that, my doctor said to avoid anything with Epinephrine. (I will also add, that I have diagnosed anxiety disorder and a mitral valve prolapse) I regularly take Prozac and Xanax. 

Two weeks ago, I told my dentist not to use epinephrine, so she chose Carbocaine. I was told it was epinephrine-free. Guess what? After six shots, (four hour appointment!) I got dizzy, nauseated, felt like fainting, rapid heart, and shaking! Luckily I had a Xanax with me and took it. It helped some. But I really felt shaky all day after that. 

Today, I needed the crowns put on my teeth. So I pre-medicated with a Xanax with the advise of my doctor. My dentist only gave me a very small amount...one shot. Within two minutes of the injection, I had a similar reaction, but not anywhere as bad as the "six shot event". I got dizzy and a really rapid heartbeat. I told her to stop and I would take the pain without any drugs. I am at a quandary as to what to do about this. God forbid I needed local surgery at some time, or what happens when I need to have a tooth filled? Is this an allergic reaction to the Carbocaine or other reaction? I have used Novacaine for years for regular dental work, so why am I reacting now? Should I get allergy tested? Should I see an anesthesiologist for a consultation on this issue? And might acupuncture work for pain control? I truly appreciate your advice and any recommendation you might give me. Thanks so much 

Thanks for sharing your story with me. The description you give of your reaction to the injection with lidocaine is very very typical of the effects that results from the absorption of local anesthetic agents of any type (including carbocaine) into the blood stream. In most cases, only small amounts of anesthetic over time are absorbed. If a blood vessel is close to the site of injection, or the needle actually enters a blood vessel, far more anesthetic is absorbed, quickly, and produces the unpleasant symptoms you've described. 

Very often, when patients have the reaction you've described, it is attributed to "allergy" to the local anesthetic, which it is not, or to the effects of the epinephrine that is often part of the local anesthetic formulation (it's not that either). The purpose of adding epinephrine in fact is to limit the absorption of local anesthetic into the blood, and to prolong the effect of the anesthetic itself. If the needle is inserted into a blood vessel, and the anesthetic contains epinephrine, the patient will often experience a sudden rapid increase in heart rate. This may be unpleasant, but is also used by anesthesiologists as a useful warning sign, indicating that the needle should be repositioned! 

After six shots of local anesthetic it is possible that you had been given close to the maximum amount of local anesthetic. Because eventually the anesthetic is, over time, absorbed, the more you are given within a space of time, the more possible it is to begin to experience side effects, even if the needle is accurately positioned. With your history of panic attacks it is also possible that many of the symptoms you have described could be due, pure and simple, to an overwhelming anxiety attack. Four hours in a dentistﾒs chair is enough to give anyone a fright! 

My suggestion to you is that you ask your dentist to arrange for you to receive a decent amount of intravenous sedation for any significant dental work in the future. The dentist may not be able to do this herself, but there are anesthesiologists who do this kind of work, and even companies devoting themselves entirely to this service. There is no reason, with modern anesthesia and dentistry, why you should not have a sa fe, tolerable or even pleasant experience at the dentist next time. 

I asked a question priously about this topic. I had a procedure done using lidocaine and had severe palpatations and arrthmias after the injection in my forehead. So doc said it was due to epinephrine. We did a second procedure and used carbocaine plain (without epinephrine) I had the same reaction it started right after the injection was done and lasted about 10-15 minutes. I have read carbocaine without epinephrine can also cause these symptoms everybody thinks I am crazy but this is really happpening to me. I need a third procedure in 5 more days. What should I do this time. 

Thanks for your interesting question.ﾠ As always, the best way to sort this out is for your doctor to carefully evaluate what happened (both times) by taking a careful history, doing a thorough physical exam, and examining the records, to figure out whether you have any predisposing factors or underlying health problems. Questions that might usefully be asked include the following: Do you have any other known allergies? Are there any other medicines you are known to have had a reaction to? Is there any possibility that you are allergic to latex rubber (the material of which the doctor's gloves are made)? Where there any other symptoms that might suggest you were having an allergic reaction, such as dizziness and low blood pressure, wheezing and difficulty breathing, skin rash or hives, etc? Have you had similar experiences unrelated to medical procedures? Do you have any history of heart disease? Have you had an EKG (electrocardiogram)? (You probably should have one) If your problem is indeed related to the local anesthetic, it is possible that the reaction was due to rapid or excessive absorption of the local anesthetic into the bloodstream.ﾠ Any local anesthetic, including lidocaine and carbocaine, if absorbed into the bloodstream in sufficient amounts, can cause symptoms that include dizziness and lightheadedness, numbness around the mouth, tinnitus (a ringing noise in the ears), or a metallic taste.ﾠ Your doctor takes precautions to prevent this absorption, by aspirating (drawing back) on the syringe before injecting to make sure the needle is not in a blood vessel.ﾠ Nevertheless, absorption does take place over time. Both lidocaine and Carbocaine, also called mepivacaine, are amide local anesthetics.ﾠ The other major group of local anesthetics are the esters. ﾠIf you need another procedure, and local anesthetic must be used, it might be worth trying a medication from the ester group, such as procaine or chloroprocaine.ﾠ Overall, allergic reactions are more commonly associated with the esters than the amides, however. Methylparaben is an ingredient of local anesthetic preparations that is thought to contribute to untoward reactions to these useful drugs.ﾠ Methylparaben-free formulations are available for most local anesthetics, and your doctor might consider using one of those. It is hard to know how much of a risk is posed to you by these reactions you have had.ﾠ Your doctor needs to decide whether any future procedures ought to be done in a monitored setting, where your heart rate, blood pressure and other vital signs can be carefully and continuously watched. It might even be worth considering whether your forthcoming surgery - you don't say what it is - should be done under general anesthesia, thereby avoiding the need for local anesthetic altogether.