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A 45-year-old male with alcoholic cirrhosis is seen in the ED because of a laceration of the scalp. Of the following local anesthetics, which would potentially be toxic?

a. Lidocaine
b. Benzocaine
c. Procaine
d. Tetracaine


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The answer is a.

Ester-type local anesthetics are mainly hydrolyzed by pseudocholinesterases. Amide- type local anesthetics are hydrolyzed by microsomal enzymes in the liver. Of the listed agents, only lidocaine is an amide and can be influenced by liver dysfunction.