Lidocaine sensitivity or poor stress response?

[bumpkin]

I had a biopsy done almost a week ago where they used lidocaine as the local anesthetic.. I hadn't been given any anesthetic (local or IV) in several years, last time would've been long before the dysautonomia began, but I never had trouble with 'em in the past. 

Knowing dysautonomia can change these things, before they got started I asked about what anesthetic would be used. When they said they'd just be using lidocaine, that at least sounded better to me than epinephrine, so I wasn't worried about it. 

My nervous system had a really rough time throughout the whole procedure from prep to finish, but I got it over with and came out of it with just the pain from the biopsy itself (the lidocaine wasn't much help) and the trauma from having to force myself to hang tight and ignore the pain and the overwhelming fight-or-flight response for 15-20mins. I didn't have any apparent reactions otherwise and they watched me for a few minutes and sent me on my way. 

I recognized the stress of it was immense on my system, so I anticipated being a little run down for the next day or two, but the following day my energy seemed way down from its usual low, and the brainfog each day since then has been worse. Vitals have stayed normal aside from my blood pressure being low (low for me) half the time, hanging around 90/60 - 100/70 when supine and when standing. My pulse oxygen seemed to take a slight dip from 99% to 97% at times but stayed around 98-99%. They said to watch for signs of infection, but I haven't had any fever, and the area where they stuck me seemed to heal up just fine within a day or so (still a little sore, but nothing looks or feels off). 

Has anyone ever had a poor reaction to lidocaine? I'm wondering if it maybe was just the overwhelming stress of it all that's wiped me out more than usual, or if the lidocaine could have upset things a bit. I know it doesn't take much in our condition, but this biopsy experience seems to have set me back a week.. It's been much harder to function, and I don't have much to go off of to know how to turn it around since I'm not really sure of the culprit. I guess it could also just be hormones messing with me again and the timing could be a coincidence, it feels like it's always something..

[RecipeForDisaster]

I kind of remember this happening from my last one. I think I couldn’t stand for a while afterwards.

I was amazed at how painful it was, and was told to just push through. I don’t know if local anesthesia doesn’t work well on me (I guess this goes with some of our issues), but I don’t think lidocaine could give you a problem much later, as it is gone from your system relatively quickly. I think that going through that trauma might be enough to explain it. 
 

[bumpkin]

29 minutes ago, RecipeForDisaster said:

I kind of remember this happening from my last one. I think I couldn’t stand for a while afterwards.

I was amazed at how painful it was, and was told to just push through. I don’t know if local anesthesia doesn’t work well on me (I guess this goes with some of our issues), but I don’t think lidocaine could give you a problem much later, as it is gone from your system relatively quickly. I think that going through that trauma might be enough to explain it. 
 

Thank you for the reply -- Yeah, I definitely sat up slowly like usual, but had to stay put for a bit to wait out the worst of the shakiness before heading out.. It was embarrassing but the nurse understood how some nervous systems just don't take that kinda stress too well. Once I got back to my car I still had to sit for awhile before I could get going again.

I was caught off guard by how much pain I was in too, they were a very empathetic team and actually tried to give me breaks between samples, but I told them to please keep going til it was done.. Taking breaks would only drag out that panic response, and I needed that part over with asap. But even with pushing through it couldn't be over soon enough lol, the trauma was done. 

Whole thing kinda stung worse after learning the results were inconclusive too.. I'm sure they're going to tell me to come back for a do-over, but I don't think I'll be getting another one of those done.. can't guarantee the next one isn't also inconclusive, and I can't afford to be any less functional.. this week's been a bit scary, feels like my old baseline gets farther away every time my nervous system takes another insult 😔

[RecipeForDisaster]

That stinks! I was super shaky, too. Thank God my friend drove me. Didn’t it feel like it took forever? I thought punch would mean one quick action. I ee many people saying it was totally painless. I guess their local anesthesia worked!
 

My results didn’t come back for maybe 6 weeks. I can’t believe you have yours already! Even worse that it was inconclusive. My first one was, many years before, but they didn’t offer to redo it. They didn’t get a sweat gland in one of those samples. 
 

I know exactly what you mean about kind of permanently setting back your nervous system. I get so mad when I’m unnecessarily startled or something - it feels like I don’t ever totally recover. 

[Sushi]

13 hours ago, bumpkin said:

I had a biopsy done almost a week ago where they used lidocaine as the local anesthetic.. I hadn't been given any anesthetic (local or IV) in several years, last time would've been long before the dysautonomia began, but I never had trouble with 'em in the past. 

Knowing dysautonomia can change these things, before they got started I asked about what anesthetic would be used. When they said they'd just be using lidocaine, that at least sounded better to me than epinephrine, so I wasn't worried about it. 

My nervous system had a really rough time throughout the whole procedure from prep to finish, but I got it over with and came out of it with just the pain from the biopsy itself (the lidocaine wasn't much help) and the trauma from having to force myself to hang tight and ignore the pain and the overwhelming fight-or-flight response for 15-20mins. I didn't have any apparent reactions otherwise and they watched me for a few minutes and sent me on my way. 

Here is the thing: when you get lidocaine as a local anesthetic by default it will contain epinephrine. You have to ask for lidocaine without epinephrine  which they are usually happy to do though it requires a bit higher dosing. I also learned this the hard way but now and careful in requesting lidocaine without epinephrine. They put in epinephrine as it makes the lidocaine last longer and also reduces bruising but I have had major procedures like the surgical placement of a pacemaker with just lidocaine.

[MikeO]

5 hours ago, Sushi said:

Here is the thing: when you get lidocaine as a local anesthetic by default it will contain epinephrine. You have to ask for lidocaine without epinephrine  which they are usually happy to do though it requires a bit higher dosing. I also learned this the hard way but now and careful in requesting lidocaine without epinephrine. They put in epinephrine as it makes the lidocaine last longer and also reduces bruising but I have had major procedures like the surgical placement of a pacemaker with just lidocaine.

Cardiology used lidocaine when they put in and took out my ILR. can't say i felt any pain but the procedure did leave a crappy scar and took forever for the bruising to heal. I did almost face plant when the ILR was put in so i hung out at the clinic for a bit.

that's it. all i can say about the med. 

[bumpkin]

7 hours ago, RecipeForDisaster said:

That stinks! I was super shaky, too. Thank God my friend drove me. Didn’t it feel like it took forever? I thought punch would mean one quick action. I ee many people saying it was totally painless. I guess their local anesthesia worked!
 

My results didn’t come back for maybe 6 weeks. I can’t believe you have yours already! Even worse that it was inconclusive. My first one was, many years before, but they didn’t offer to redo it. They didn’t get a sweat gland in one of those samples. 
 

I know exactly what you mean about kind of permanently setting back your nervous system. I get so mad when I’m unnecessarily startled or something - it feels like I don’t ever totally recover. 

This was actually for a thyroid nodule fine needle aspiration biopsy, they made several passes to take multiple samples, lots and lots of needle-jiggling around in there. Afterward it felt like I'd taken a really nasty kick to the neck 🤕 Then I wondered why I knew what a hard kick to the neck felt like, but remembered that's just the type of life experience you gain growing up with brothers 😅 

I've read about those skin biopsies recently too though, they don't sound like a good time at all. I think I had what might've been a kinda similar one done once for a skin spot that turned out to be nothing, but they did that procedure on-the-spot minutes after I brought it to the dr's attention.. I swear that dr couldn't whip out the lidocaine and forceps fast enough to squeeze that biopsy in before my appt was over 😂

[RecipeForDisaster]

7 minutes ago, bumpkin said:

This was actually for a thyroid nodule fine needle aspiration biopsy, they made several passes to take multiple samples, lots and lots of needle-jiggling around in there. Afterward it felt like I'd taken a really nasty kick to the neck 🤕 Then I wondered why I knew what a hard kick to the neck felt like, but remembered that's just the type of life experience you gain growing up with brothers 😅 

I've read about those skin biopsies recently too though, they don't sound like a good time at all. I think I had what might've been a kinda similar one done once for a skin spot that turned out to be nothing, but they did that procedure on-the-spot minutes after I brought it to the dr's attention.. I swear that dr couldn't whip out the lidocaine and forceps fast enough to squeeze that biopsy in before my appt was over 😂

Ohh I made a silly assumption because of what forum this is! That doesn’t sound fun, either. Multiple passes are miserable!

 

Funny you should say that - I have to see a dermatologist for a mole in a couple of weeks, and I think they’ll want to biopsy or take it off on the spot, too. I bet I won’t have good anesthesia there, either. 

[bumpkin]

6 hours ago, Sushi said:

Here is the thing: when you get lidocaine as a local anesthetic by default it will contain epinephrine. You have to ask for lidocaine without epinephrine  which they are usually happy to do though it requires a bit higher dosing. I also learned this the hard way but now and careful in requesting lidocaine without epinephrine. They put in epinephrine as it makes the lidocaine last longer and also reduces bruising but I have had major procedures like the surgical placement of a pacemaker with just lidocaine.

Thank you Sushi, this is what part of me started wondering too, because it was such a bad ride.. I thought maybe there was a chance I did receive something I shouldn't have, even though it sounded like it was supposed to be just lidocaine. I will have to remember this if there's ever a next time, thank you 🙏

I just remembered I can also try looking at their notes in the portal, maybe there's a chance they specified what type of lidocaine they used.. it looked like a fairly detailed report on how the procedure itself went, I just didn't read too far into that since I quickly realized it was just a report and not the lab analysis, the actual results were posted the next day. 

[bumpkin]

1 hour ago, MikeO said:

Cardiology used lidocaine when they put in and took out my ILR. can't say i felt any pain but the procedure did leave a crappy scar and took forever for the bruising to heal. I did almost face plant when the ILR was put in so i hung out at the clinic for a bit.

that's it. all i can say about the med. 

I had to look that one up.. I've said it before and no doubt I'll say it again, ohhh, the things we subject ourselves to just to try and get some answers to our health mysteries 😩

Sushi makes a good point, it begs the question how much of the time it's straight lidocaine being administered, or whether we could've actually been reacting to a little epinephrine in there, or if it was actually lidocaine without epinephrine and the orthostatic intolerance maybe creeps in on us once the procedure is over. 

I'll be more particular asking about it if there's ever a next time.. I absolutely told the nurse that I was relieved to hear it was just going to be lidocaine and not epinephrine due to the dysautonomia issues.. so if I still received a little epinephrine after mentioning it to them, well.. that would make for a very disappointing standard of healthcare to say the least 😣

[MikeO]

12 minutes ago, bumpkin said:

I had to look that one up.. I've said it before and no doubt I'll say it again, ohhh, the things we subject ourselves to just to try and get some answers to our health mysteries 😩

Sushi makes a good point, it begs the question how much of the time it's straight lidocaine being administered, or whether we could've actually been reacting to a little epinephrine in there, or if it was actually lidocaine without epinephrine and the orthostatic intolerance maybe creeps in on us once the procedure is over. 

I'll be more particular asking about it if there's ever a next time.. I absolutely told the nurse that I was relieved to hear it was just going to be lidocaine and not epinephrine due to the dysautonomia issues.. so if I still received a little epinephrine after mentioning it to them, well.. that would make for a very disappointing standard of healthcare to say the least 😣

I did bring up with the provider asking if i had a reaction to the lidocaine. The MyChart message went crickets which i guess is ok cuz i never plan on doing a ILR again or any other semi invasive procedure unless absolutely necessary. Hindsight being 20/20 i should have asked for a 14 day zio patch. 

[bumpkin]

23 minutes ago, RecipeForDisaster said:

Ohh I made a silly assumption because of what forum this is! That doesn’t sound fun, either. Multiple passes are miserable!

 

Funny you should say that - I have to see a dermatologist for a mole in a couple of weeks, and I think they’ll want to biopsy or take it off on the spot, too. I bet I won’t have good anesthesia there, either. 

It's ok lol that is apparently the most common biopsy people have done in this condition adter all, but the thyroid nodules would also make a lot of sense since everything seems to lead back to hormones being outta whack.. But with my thyroid numbers being in normal range (and the normal range of thyroid labs apparently not having much value since my symptoms seem to really point to thyroid problems) I only learned of the thyroid cyst from a car accident neck MRI.. I doubt any doctors would've ever looked for a nodule otherwise. They say it's really common but they can also cause issues for people, it'd be nice if the medical field would catch up with that, kinda wonder how many folks are struggling with unaddressed thyroid concerns simply because it's not the script the doctors follow.

Good luck with your derm appt, just remember don't be afraid to remain firm-but-polite if they try to sell you on anything that you might not be entirely comfortable with.. You can always give yourself time to think about it and come back. I've had drs spring painful things on me a few times where I wished I'd gone into it with more presence of mind to decline. But they just seem so friendly and agreeable when they ask to catheterize you on 10 seconds notice 😭

[bumpkin]

2 hours ago, MikeO said:

I did bring up with the provider asking if i had a reaction to the lidocaine. The MyChart message went crickets which i guess is ok cuz i never plan on doing a ILR again or any other semi invasive procedure unless absolutely necessary. Hindsight being 20/20 i should have asked for a 14 day zio patch.

Well that's lame they didn't message you back, we're left in the dark on so much as it is.. but for sure hindsight is 20/20, at least we can learn from the experiences, bet they're not counting on that lol. 

It looks like my chart just says it was 1% lidocaine, I remember the nurse telling me there'd be a pinch and a burn but that's all they told me about it. There's a good chance that the nurse wouldn't have necessarily known for certain whether it contained some epinephrine since it sounds like just an odd standard where they still call it lidocaine anyway. 

[RecipeForDisaster]

9 hours ago, bumpkin said:

It's ok lol that is apparently the most common biopsy people have done in this condition adter all, but the thyroid nodules would also make a lot of sense since everything seems to lead back to hormones being outta whack.. But with my thyroid numbers being in normal range (and the normal range of thyroid labs apparently not having much value since my symptoms seem to really point to thyroid problems) I only learned of the thyroid cyst from a car accident neck MRI.. I doubt any doctors would've ever looked for a nodule otherwise. They say it's really common but they can also cause issues for people, it'd be nice if the medical field would catch up with that, kinda wonder how many folks are struggling with unaddressed thyroid concerns simply because it's not the script the doctors follow.

Good luck with your derm appt, just remember don't be afraid to remain firm-but-polite if they try to sell you on anything that you might not be entirely comfortable with.. You can always give yourself time to think about it and come back. I've had drs spring painful things on me a few times where I wished I'd gone into it with more presence of mind to decline. But they just seem so friendly and agreeable when they ask to catheterize you on 10 seconds notice 😭

I am pretty hesitant to consent to things in general. I always want to be sure it’s necessary and safe - I don’t do well with so many things. But in this case, I’ve waited months for the appointment, and if the mole might be bad, I do want to get rid of it. I just hope it isn’t super painful!

[MikeO]

9 hours ago, bumpkin said:

Well that's lame they didn't message you back, we're left in the dark on so much as it is.. but for sure hindsight is 20/20, at least we can learn from the experiences, bet they're not counting on that lol. 

This whole clinic experience was a lesson for me. wrote it off and learned from it. Just a bit more leary of Health care designed by committee. 

[bizbiz]

This thread is interesting to me.

I had dental work done a year ago which required local anaesthetic - I stressed the importance of a local without adrenaline, and the dentist complied. Within ten minutes, I felt...sedated and drunk. It was strange! I had an intial hot flush (which I thought was perhaps nerves), and then felt extremely cold - to the point of shaking and twitching. I managed to get through the appointment, but was unable to discuss anything with the dentist afterward, as I felt I was going to faint. I was able to pay (barely - I couldn't stop shaking), and returned to the car where my husband was waiting to take me home. I continued to feel cold and shake for another half hour to hour. It seemed to wear off after that, and by the afternoon I was back to (my POTSY) normal. 

I called the dental practice a couple of weeks later, and they confirmed that I received local without adrenaline. I'm now wondering if I had a reaction to that particular anaesthetic, or if it was possibly the topical anaesthetic she applied before the injection? Needless to say, I am extremely nervous to now have any dental work done.

A week after this, I had major surgery under General Anaesthetic, and had no issues with recovery or unexpected side effects.

[Sarah Tee]

@bizbiz, I’ve had trouble at the dentist too. When I pluck up the courage, I am going to suggest a practice session, where I have the anesthetic as a test run, so there’s no pressure or stress if it makes me feel unwell. No doubt they will be happy to charge me extra!

Do you think you you find out which anesthetic you had?

(No pressure but I would be interested to hear so I can avoid it if you are able to find out.)

[Sarah Tee]

I happened to see on another forum that lidocaine caused problems for a couple of people with ME/CFS. Just thought I’d mention it. I know anyone can have an adverse reaction to anything, but as ME/CFS seems to have autonomic aspects I thought it might be relevant.

[bumpkin]

On 5/7/2024 at 10:08 PM, Sarah Tee said:

I happened to see on another forum that lidocaine caused problems for a couple of people with ME/CFS. Just thought I’d mention it. I know anyone can have an adverse reaction to anything, but as ME/CFS seems to have autonomic aspects I thought it might be relevant.

I have to wonder if those people had "lidocaine without epinephrine" or if they got the lidocaine that isn't truly plain lidocaine, like how Sushi pointed out that we apparently need to be painfully specific about the "without epinephrine" part. 

I definitely don't doubt that people could react to "lidocaine without epinephrine" too though. ME/CFS is tedious, I suffer from it but I only know as much as I do because my partner is a very severe (primarily housebound and mostly bedbound) ME case -- so I've got a whole portfolio of laminated printouts prepared in case we ever have to go to the ER, including a few on anesthesia that I'd found on the American ME/CFS Society site (they cite info from Dr. Cheney and Dr. Lapp and others). I have a tendency to assume this stuff doesn't apply to me as much, but after that experience the other week I know I've got a lot more reading into it to do. 

[bumpkin]

On 5/1/2024 at 12:34 PM, RecipeForDisaster said:

I know exactly what you mean about kind of permanently setting back your nervous system. I get so mad when I’m unnecessarily startled or something - it feels like I don’t ever totally recover. 

Don't know why I'm surprised to find that it can happen in ways we can measure, too.. Today it finally dawned on me that my blood oxygen has taken a slight dip ever since the biopsy. I made note of it the day after the procedure, and I just ignored it and figured it'd bounce back in a week or whatever, but it's stayed there, unless I do breathing exercises to help bump it up, but it always goes back down again later. 

And it's not like I really believed all that oxygen was actually getting into my cells or being used effectively anyway when it was at 99%, but dang..  seeing it at 97% all the time now just feels like I dropped a $50 bill somewhere lol, really needed that crappy baseline to stay where it was. 

[Sarah Tee]

@bumpkin, yes, in the posts I saw, people were surprised by it, as they had double checked there was no epinephrine, thinking that would be the problem.

I had a look at a couple of medical suppliers, and lidocaine without epinephrine is listed as a product. I think that medical and dental staff would learn that epinephrine is contraindicated for patients with heart failure, so avoiding epinephrine is a concept that they would be familiar with, especially if the patient listed it under the “allergies” section on their intake form.

But them people can be careless or make mistakes, so who knows.

I suppose to be absolutely sure you would need to check the packaging of the product yourself, or ask your support person to do so. I will certainly be asking a lot more questions when I have to have dental work or a biopsy.

Another burden on us!

I hope you are feeling a bit better.

[bizbiz]

Hi @Sarah Tee 

Quote

Do you think you you find out which anesthetic you had?

I had Scandonest 3% Plain.

I've had it before in the past, but it was during a POTS remission. I don't recall having any side effects while in the dental chair, however I was extremely fatigued (again, almost feeling lightly sedated) afterwards for hours, but at the time I just put this down to exhaustion from the stress and nerves. Also, that particular dentist was quite sympathetic after I had requested as little of the local anaesthetic be used as possible. This more recent time, whilst the dentist complied with my request for an local without adrenaline, I'm not sure how seriously she listened when I asked her to inject as little as possible. She also applied a topical anaesthetic before injecting, but I can't really see that causing any issues.

[Sarah Tee]

@bizbiz, thank you, I will watch out for that one. I know we are all different but it seems people with autonomic problems tend to also have problems with local anesthetic.

Re dentists: It is hard to trust what people are doing sometimes, isn’t it. Which is a sad state of affairs!

[adigitalashley57]

Lidocaine is a Mast Cell Liberator even without the epinephrine. My guess is that is what caused it. MCAS /Mast Cell activation syndrome is very common in POTS/EDS/Autonomic Dysfunction. 

I've had reactions, hot flashes, heart racing, and blood pressure issues, even from the smallest pinprick of lidocaine to remove a mole and also from the orajel they put on the tooth before doing the novocaine shot... 

On Dr. Afrin's list of medicines not to use on MCAS patients, there is a preferred local anesthetic that is apparently easier to tolerate, but I can't remember the name offhand.