M400 MANAGING A CASE OF REPORTED LOCAL LIDOCAINE ALLERGY IN A PREGNANT WOMAN DURING COVID-19 PANDEMIC

Abstract

We report how we diagnosed and managed a case of reported local anesthetic allergy in a high-risk pregnant woman during the COVID-19 pandemic via telemedicine. We were consulted by the obstetrician for lidocaine allergy in advance of a spinal block for an elective cesarean section in a 23-year-old woman at 34 weeks of gestation. The patient had a past medical history of ulcerative colitis and a surgical history of having a colectomy and ostomy. The patient reported a previous episode of localized hives and swelling shortly after undergoing a dental procedure that was thought to be secondary to her receiving a lidocaine injection. She denied cardiopulmonary and gastrointestinal symptoms, anxiety or delayed reactions. Therefore IgE-mediated hypersensitivity was possible. Due to the COVID-19 pandemic, we conducted the initial assessment and the subsequent planning with multiple providers involved in the case through a Telehealth route. At 38 weeks of gestation, in a pre-delivery room with fetal monitoring, the patient passed both skin prick and intradermal testing for lidocaine (10mg/ml), preservative free lidocaine (10 mg/ml) and preservative free bupivacaine (2.5 mg/ml). Subsequently, she passed a subcutaneous skin challenge with 1 ml of preservative free lidocaine (10 mg/ml). A few hours later, she delivered a baby uneventfully by cesarean section under spinal block using local preservative free lidocaine. We report the management of reported lidocaine allergy on a pregnant patient during COVID-19 pandemic via both telemedine and pre-delivery on-site skin testing. We successfully removed the label of lidocaine allergy immediately before her delivery.