What local anesthetic should be avoided in patients with a severe allergy to ester type anesthetics?

In the context of local anesthetics, it's essential to understand the distinction between ester and amide types. Procaine is an ester anesthetic, while lidocaine, bupivacaine, and mepivacaine are amide anesthetics. Patients with a severe allergy to ester-type anesthetics are likely sensitive to the chemical structure and metabolism of these agents, which can lead to allergic reactions.

Procaine should be avoided in patients with a known severe allergy to esters because it is an ester anesthetic and could trigger an allergic reaction. On the other hand, the amide anesthetics (like lidocaine, bupivacaine, and mepivacaine) do not share the same chemical structure and are generally tolerated well by individuals with ester allergies. Therefore, when considering a local anesthetic for someone with an ester allergy, the amide class is typically the safer choice. This understanding plays a crucial role in ensuring patient safety and preventing adverse reactions.