I’m due to have a gynaecological out-patient procedure in the next few weeks, which will involve the need for a local anaesthetic. It can’t be carried out without some form of pain relief for me. I underwent a similar, but less invasive procedure, just under a year ago. After advising the gynaecologist and staff then, that I was on 1.25 of Bisoprolol, they insisted that lidocaine would be fine for me. It wasn’t - After that procedure, I felt like I was going to feint and my BP plummeted to 55/37, with an HR of 50. I was wheeled off to recover for an hour, monitored by a nurse and no more was said.
It was only afterwards that I read the NICE guidelines that lidocaine can produce a severe reaction with bisoprolol and can cause cardiac arrest, so isn’t to be given.
I asked what anaesthesia it would be for this next procedure and was told I’d be given lidocaine again. When I mentioned what happened before and the reasons I can’t be given it, I don’t think I was fully believed.
If you’re taking bisoprolol for Afib and have had a local anaesthetic for a recent surgical procedure (non dental) and live to tell the tale, what did they give you? Any advice greatly appreciated so I can request a specific type this time.
by the way, I know none of you can give medical advice and of course, it’s up to the hospital what they give me (within reason) I’m just after experiences.
Thankyou.
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Teresa156
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Thankyou. Yes, it wasn’t ideal 😳 I’m hoping that someone will be able to advise what I can be given instead ( there must be an alternative) as I’m worried the hospital will dither…
Might it be worth contacting your cardiologist's secretary, explaining what happened and to ask the cardiologist for advice?
The hospital where you had the reaction to lidocaine should have details of what happened in your notes which should be visible to your current team. How dare they not believe you! I would be foot stamping on this one.
Thankyou - I hadn’t thought of calling my cardio’s secretary - I’ll give that a try Monday. They didn’t say actually say they didn’t believe me outright, but the nurse said that “we haven’t had that happen ever before” and “it must have been just a reaction”. The gynaecologist just said they would sort out something….but then added it was usually lidocaine. I just could tell they weren’t convinced, but yes, it was all recorded a year ago as the nurse kept taking my BP and noting it.
You must ensure that they don’t do that to you again. Have you spoken to your Cardiologist or EP? That is no joke. What happened to you?
I wish I knew what was used on me in Florida when I had my disc ablated. I had no issues. Do you have pain management doctors where you are? Perhaps you could even call them to see if they would recommend. Here in the states, a pain management doctor is an anesthesiologist.
Thankyou. I recovered from it after about an hour last year, but yes, I just want to avoid a similar thing and I guess I’ll have to point out the NHS guidelines we have here on line, if they question it again. I only posted on here to see if anyone else has had a different anaesthetic with no reaction that I could suggest to them.
I really need this procedure and want to make sure I don’t feel the pain as it will involve pain 😳 No, we don’t have pain management doctors here. Unfortunately I don’t have an EP that I can call on either. I haven’t seen a cardiologist for over a year as our NHS has got a backlog ( long story) but I’ll try calling their secretary on Monday to ask for their advice for an appropriate anaesthetic for this procedure.
The nurse for my EP usually has answers for me and if she doesn’t, she will check with him and get back to me. They deal with so much of this. They often seem to know more than the doctor lol I think the doctors like to concentrate on what they are best at which is in surgery. Right now unless he changes it, I will only see my EP four times a year. Most of that is probably checking on my pacemaker and readjusting it as we go along. He is taking it slow lowering my heart rate because of how high it had been.
I do not like pain management as the name of the treatment here. It once was doctors that really pushed drugs. Now things are much stricter and to be a pain management doctor. You must be an anesthesiologist, which FYI they are the highest paid type of doctor here, I don’t mean someone like Dr. Wolf but in general the pain management I have received was for very bad accident injuries after being hit by an 18 wheeler. It was a time I could not move my neck. Even now I must talk to my EP or anything spinal because there are still issues where you could end up with blood clots, etc. If you are on an anticoagulant, you could even bruise inside and bleed without anyone noticing. If you don’t speak up for yourself, no one else will so please be careful. Can’t they put you under what they call twilight here? You are awake, but they do it through intravenous. I had previously with catheterization and also when I had my Cataracts done. I had no side effects. As a woman who has had issues like you may have believe me I feel for you these days I need to be sedated period. It does not have to be full-blown anesthesia, but I don’t want to know anything lol. Sometimes medicine can seem so archaic.
Thankyou for your reply and for sharing all that you’ve been through and it sounds like a lot.
The problem is now that I really don’t know what anaesthetic would be best for me even intravenously. I’m totally in the dark. I wish I could trust the hospital next time, but not sure if I can. I don’t want them to try and force something similar on me next time either. They were even going to give me ibuprofen last time too but I had to remind them again of bisoprolol and afib.
I just want to have some idea from someone who has had an anaesthetic that they know didn’t react with bisoprolol. I’ve looked on line and google and can’t find anything either, which makes me think there might not be, but there must be.
you are lucky to be given pain relief for this procedure. I wasn't and told them they would have to stop as I was about to faint.When i went the next time the doc. said i can do this more gently and take an 'indepth smear' which will prob. give the same result. It was Just about bearable so this might suit you. It was also a lot quicker than the earlier more invasive procedure.
Sorry to hear what you went through, these procedures are horrible and never pain free whatever they do are they? Last year I had to have an anaesthetic as the gynae had to physically turn my womb round and take a biopsy. I’m afraid it’s even more invasive this time as it involves cutting & hopefully possible removal of a large fibroid growth, to be exact, so I’m going to need an anaesthetic. I don’t think they’d do it on me without some form of pain relief and I don’t think I’d let them!
I have been there, but not without anesthesia. I had a hysterectomy because of being equal to a seven month pregnancy. You need to find a doctor that doesn’t treat this type of a problem you have as if you are having a tooth pulled.
I’m afraid I won’t get a choice in the UK and they all follow standard practice. Yes, they do need to treat it like I’m not having a tooth pulled. I’m sorry you had to have a hysterectomy ( it’s been mentioned that I might have to have one of those if all else fails). A long way down the line yet though.
I was afraid that was the case for you. It can be an awful thing to deal with I know. Once I had the surgery I was so much better. I wish I had had it done much earlier. My daughter needed one before she was 40. It appears to be something in our family. Healing, thoughts and prayers to you that whatever they are going to try worms.🙏🏻
It’s very kind of you to come back. I’m sorry you’ve been through it all too. I’ve always had problems with my hormones abd things all my life, so it’s nit surprising that it’s coming to a head. I wish it wasn’t though. It’s not easy sometimes is it, what with Afib too? These things are sent to try us, or so they say. Sending hugs to you 🤗 x
What about IV paracetamol? With a local not containing adrenaline? I had Pacemaker implanted with that and a 3 hours procedure for a replacement of the wires - it wasn’t completely pain free but bearable.
Quote:- Mepivacaine hydrochloride is available with or without adrenaline/epinephrine and articaine is available with adrenaline. In patients with severe hypertension or unstable cardiac rhythm, mepivacaine hydrochloride without adrenaline/epinephrine may be used.
Thankyou so much for your reply. I have been told to take two paracetamol and ibuprofen an hour before this procedure. I’ll obviously skip the ibuprofen because of the bisop and the Afib and I’ll probably take cocodomol ( as I know I’m ok with that) so I don’t suppose they’ll give me more paracetamol intravenously. Thanks so much for finding out the details for the other anaesthetic though….I’m going to write that down and take it with me 😊 as I have to take this matter into my own hands I think. I really appreciate you coming back with that.
I’ve looked a little more into the mepivacaine hydrochloride….I don’t think the adrenaline is the problem ( though I do want to avoid it anyway of course) and this anaesthetic seems to be given to stop palpitations occurring and for those who have hypertension and unfortunately I’ve got the opposite 😳
Thankyou though, for taking the time to try and help.
surely you will have a pre-assesment where you can discuss your worries with the pre-assesment nurse, who should then discuss this further with the doctors?
Thankyou for coming back. Unfortunately no, not for these procedures, as it’s not like a general surgery that needs a pre op or anything. I had an internal this week with the gynae who also did a biopsy there and then ( without any anaesthetic) and told me about this upcoming next procedure I’ll need. It was only at this appointment that I asked what anaesthetic they’d be using, hence this post. Thankyou though.
just looked up this in the British national formulary ( should be every doctors and nurses go to ) and this is what it said
BisoprololLidocaine is predicted to increase the risk of cardiovascular adverse effects when given with Bisoprolol. Manufacturer advises use with caution or avoid. Severity:SevereEvidence:Study
I had that happen in a dentist chair when I was given lidocaine for dental work and I wasn’t taking Bisoprolol. I was under the impression that we AFers shouldn’t have Lidocaine period?
I’m sorry you had it the reaction too. I made it really clear last year, to two different gynaecologists that I was taking daily Bisoprolol and had to be careful with anaesthetics. Both said I’d be fine with lidocaine. Last year, after I found the NICE guidelines ( after it all happened, so too late) I called the hospital and spoke to a Nurse. I told her what had happened & that I shouldn’t have been given it and she said ‘ but we give it to everyone’ and ‘we’ve never had it happen before’. I just give up really.
I had a similar reaction, scared myself and my dentist witless. I was told it’s a not uncommon reaction to the adrenaline that is usually (apparently) added to lidocaine as it reduces bleeding. There is an option to have lidocaine without adrenaline which I’ve had several times since (including two months ago when having a small lesion removed from my nose and again last week when I was having a joint replacement), and I’ve never had a problem since that first time. I’m on 5mg of Bisoprolol. Both my daughter and my mum have since had similar reactions to lidocaine with adrenaline. Daughter is young with nothing else going on, but mum also on Bisoprolol. Both have been fine with the non-adrenaline version.
I’m careful with dental procedures too, but have had adrenaline in my anaesthetic ( dentist used it by accident 🙄) and I was thankfully ok, though the anaesthetic took ages to wear off. I don’t think it was lidocaine though, but I don’t know, to be honest. Did your HR and BP drop wih the adrenaline? I have always tried to avoid the adrenaline, because I thought it was that, that could cause an Afib episode?
I’m really interested in what you had recently and the fact it didn’t affect you, which sounds great. So you had lidocaine without adrenaline and your BP didn’t drop at all? You didn’t feel faint and your HR didn’t drop significantly?
yes, my reaction was BP in boots and heart racing, nausea, sweating, faint. I told the anaesthetist before my other procedures and he said he’d use lidocaine without adrenaline and I would be fine - and thankfully I was fine. I also had IV sedation with the joint replacement but he had me on a monitor snd he reassured me after that my heart had behaved well throughout.
Thanks for coming back with what happened to you. Wow, it sounds pretty scarey. I do wonder if the anaesthetic at the dentist is slightly different, to the anaesthetic they give at other surgeries or where it’s administered, My HR, although usually low, dropped further last year with the lidocaine but my heart didn’t race at all. I did get nausea though, but not sweating. We are all different though.
I don’t think it sounds like it’s the adrenaline that I need to avoid in lidocaine, it’s lidocaine itself, but I just don’t know 🤷🏼♀️. The NICE guidance does say that Lidocaine produces a severe reaction but doesn’t say what type of lidocaine. I expect it means all types, so you might be one of the lucky ones.
It’s good they had you wired up to a monitor this time. It was only when I was wheeled out that they took my Bp last time, I could try and ask for a monitor, but I don’t expect they will ( you know what’s it’s like 😳) my expectations are low for this now, as you can tell!
lidocaine doesn’t work on me or either of my sons. Don’t think I was believed the first time when having stitches as a child and kept saying it hurt, luckily when my son also needed stitches as a small child and said it hurt, I was able to intervene. I’m going to the dentist next week so I’ll ask what they use instead, and I’ll ask my sons what is used on them. I know it was on the eldest army records that lidocaine had no effect. No guarantee that what’s used is ok with bisoprolol but might help.
Thankyou. It would be interesting to know what they use at the dentist, but I wonder if it’s different to what they use in minor surgery at hospitals and the way they use it. I’ve only ever asked to have an anaesthetic without adrenaline. I did have adrenaline by mistake last year ( dentist forgot 🙄 even though I mentioned it) but luckily no feinting and no Afib. So whatever it was, I do think is different to what I had last year at the hospital.I must admit, I did still feel pain with the procedure last year at the hospital, even with the lidocaine ( perhaps it’s only supposed to reduce pain I don’t know) , so it’s interesting that you still felt pain as well, though not great of course. Do you take Bisoprolol or a beta blocker?
Thankyou for coming back. I’m sorry to hear what you’ve been through. Unfortunately my procedure won’t have a pre-op or an anaesthetist, as it’s an outpatients minor surgery. The Gynaecologist administers the anaesthetic so I’m in their hands, so to speak.
could you ask your GP or contact the consultant surgeon who will be doing your procedure. Start with his secretary if you can’t contact him directly
I do hope you resolve this quickly.
There must surely be a different anaesthetic to give you. I suppose alternatively ask if you could stop your bisoprolol for a couple of days which obviously is not a good solution
The hospital must surely have what happened to you on your notes
Thankyou. Unfortunately I don’t think contacting my GP will be an option as this isn’t classed as a major op , it’s an outpatients scheduled procedure by a gynaecologist and you never know who you’re going to get until the day. I just know my GP wouldn’t get involved in any of it ( even if I could get an appointment!) Stopping my bisop for a couple of days isn’t an option either unfortunately ( been there, tried that) I’d have to taper off for at least a month or more and I’d go straight into Afib with adrenaline rush even after that I fear 😳
I’m hoping they’ve got it all recorded with what happened last year, but Im not counting on it.
I do remember once when I went to the dentist the anaesthetic they gave me caused problems, but the next time they gave one without adrenaline. Perhaps it’s the adrenaline in the anaesthetic they gave you
I do hope you can get an answer soon as you will be worrying right up to your admittance which won’t do your afib any good at all
OMG your situation makes me so angry for you and so upset. Horrible horrible. Horrible I wish someone could help you. No one should go through this. It sounds like they still have the mentality of pulling a tooth out when it comes to the female body and what they are doing to it. I’m so sorry 😢
Thankyou and I’m hoping I’ll be fine, just want to get it over and done with as soon as possible. Perhaps I’ll ask for gas and air ( I don’t think I can go wrong with that 😊)
There is an alternative to lidocaine that doesn't contain adrenaline which i would guess was the culprit. I have the alternative at the dentist's who know full well how lidocaine can affect the heart. My dentist told me the alternative just doesn't last quite as long.You need to refuse the treatment unless they can come up with an alternative and ask for an investigation
Print out the advice and warnings that have been given here and take them with yo u and maybe phone the gynae's secretary beforehand too so he has time to investigate ( and learn).
Thankyou for all your thoughts and help,.I don’t think adrenaline is the problem as I didn’t get palpitations. I’m ok with dentists anaesthetics which appear to be different, although I always ask for non adrenaline, but only to avoid palpitations. .
I will refer them again to the NICE guidelines as I did this time, which is what the other post is also referring to as it’s the same wording and make them read it if I have to, but hopefully it won’t come to that.
I’m up against hurdles as I don’t have a gynaecologist as such so can’t phone up any secretaries, as they change all the time. I’ve called the clinic where I need to go in the past and it’s only ever receptionists you talk to,
I don’t want to dwell really on what happened last year or ask for investigations as from experience, nothing will get done and it only causes more stress , I just wanted to know if anyone had a similar experience to me with lidocaine for minor non dental surgery but managed to have an alternative anaesthetic that didn’t cause them these same issues but it seems nobody has.
Thanks for coming back. I’m sorry to hear about your tooth problem, sounds painful. All that time pulling sounds a nightmare. I’m usually fine at the dentist with whatever injection they give me, without the adrenaline and I’ve even had the adrenaline by my desks recently and oddly I was ok.
Bisoprolol is actually contraindicated with lidocaine and the two shouldn’t be taken together according to our health system guidelines and for me, that seems to be the case or it was, for the particular area I had it in. I do wonder if somehow they gave me too much or injected into a vein by mistake but I’ll never know, as you put trust in professionals abd hope they know efst they’re doing,
The procedure I’m having isn’t supposed to be done under general, though having a general worries me too now to be honest.
I know exactly what you mean and have experienced Teresa. I take Bisoprolol and have a tooth extraction lith Lidocaine 5 years ago. Within seconds of the injection I had severe vibrating in my chest although my hands were steady. I was so frightened I thought I wasn't going to walk out of the surgery alive. It slowly wore off after about 15 minutes but I was sweaty and felt quite sick. All the dentist seemed concerned about was to say it didn't seem like an allergic reaction. At my next checkup all he said about it was that he didn't know what caused it. Now I have a broken tooth that needs extracting, but I've been too scared to even visit a dentist for over 4 years, having gone regularly all my life before. I have found out that the Lidocaine my dentist uses has adrenaline added. I've read on the internet that it makes the numbing last longer. I spoke to my GP this week and she did not know what the cause was and to just mention it if I have an anaesthetic. I just looked at the notes in my Bisoprolol tablets and they say to mention to your doctor if you are to have Lidocaine, so it is known there can be problems, but not much use if doctors and dentists aren't aware and don't believe us! With more looking on the internet under Bisoprolol today (BNF NICE site) It says 'Lidocaine is predicted to increase the risk of cardiovascular adverse effects when given with Bisoprolol. Manufacturer advises use with caution or avoid. Severity.....severe. Evidence ....Study.' Bisoprolol is a beta-adrenoceptor blocker which means it blocks hormones including adrenaline, so it would seem that the problem would be the adrenaline in the Lidocaine. I have decided to try a private dentist who will hopefully have more time to listen. I am worried about other local anaesthetics too as I need cataract and knee surgery.
It says this on the Dentistry site: Warnings: beta blockers increase the toxicity of adrenaline containing local anaesthetics. Avoid giving large doses of local anaesthetics to these patients or use an adrenaline-free solution.
Thanks for coming back - yes, we should definitely avoid it if possible and I don’t blame you for going private, as they should have more time for you and should listen. I’m private too and it is better, but you’ll probs my still have to double check and remind them every time you have a procedure 😳 I have knowingly had lidocaine during dental treatment in the past 2 years, a root canal that had to be redone ascot was infected…it was quite a procedure as took 4 hours over 2 visits. The lovely dentist convinced me I’d be ok. Because apparently there aren’t any blood vessels in the top of your mouth area where they are likely yo inject into. I trusted her and thankfully that time, it was ok. Whether I was just lucky, I’ll never know, but I did need an injection that would last. If your broken tooth is at the top, you might also be lucky? It’s a shame you’ve had to put up with it so long. Dentists always have adrenaline free anaesthetic, they just prefer the normal one.
Thank you Teresa. Yes the broken tooth is a top one, but then the extracted tooth that I had the reaction with was as well. I suppose a dentist has to work more quickly if the anaesthetic won't last as long or have to top it up. My husband recently changed to a private dentist that seems very good and takes more time with you as you say. He had to change anyway as his dentist and hospital spent 3 years referring him back and forth with the dentist saying he could not treat him and the hospital saying the dentist could!! The private dentist sorted him out in no time. Like you suggest, from now on I'll be reminding anyone if I need anaesthetic. Apparently you shouldn't use epipens with Bisoprolol either because of the adrenaline.
Best wishes to you and thank goodness there are these forums where we can share experiences.
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