A patient is allergic to lidocaine. Which local anesthetic from a different chemical class can be used?

Correct answer: B. Tetracaine

• A. Mepivacaine is also an amide — same class as lidocaine. Not safe in true lidocaine allergy.
• B. Correct. Tetracaine is an ester-class local anesthetic. True lidocaine allergy means amide allergy; switching to an ester (tetracaine, benzocaine, procaine) is the appropriate choice since the two classes have different chemical structures and metabolic pathways.
• C. Articaine is an amide-class local anesthetic — same class as lidocaine. Cross-reactivity is possible.
• D. Bupivacaine is also an amide-class anesthetic. Should be avoided in true amide allergy.