Which local anesthetic is contraindicated for patients suffering from COPD?

Prilocaine is contraindicated for patients suffering from Chronic Obstructive Pulmonary Disease (COPD) primarily due to its potential to cause methemoglobinemia, a condition where hemoglobin is altered and unable to effectively release oxygen to tissues. Patients with COPD already have compromised respiratory function and oxygenation issues; introducing a local anesthetic that might exacerbate these conditions poses a significant risk.

In patients who have respiratory diseases, maintaining optimal oxygenation is crucial. The use of prilocaine, especially in high doses or in vulnerable populations, can lead to increased levels of methemoglobin, which may contribute to hypoxemia—a condition that can severely worsen the respiratory status of individuals with COPD.

The other local anesthetics mentioned—lidocaine, mepivacaine, and bupivacaine—do not have the same significant risk of inducing methemoglobinemia, making them safer alternatives for use in patients with compromised pulmonary function. Therefore, choosing to avoid prilocaine in patients with COPD is based on ensuring patient safety and minimizing the risk of complications related to their respiratory condition.