Suspected Lignocaine Allergy: Safe Conduct of Spinal Anesthesia with Bupivacaine.

Local anesthetics (LAs) are integral to surgical and diagnostic procedures, with allergic reactions being rare yet potentially life-threatening. We report a case of a 69-year-old male with chronic obstructive pulmonary disease and suspected lignocaine allergy, posted for transurethral resection of the prostate. Intradermal testing revealed a positive reaction to lignocaine but a negative response to preservative-free bupivacaine heavy. Based on this, spinal anesthesia was planned with bupivacaine heavy and fentanyl, along with prophylactic corticosteroids and antihistamines. The surgery proceeded uneventfully. This case highlights the critical role of intradermal sensitivity testing with the intended local anesthetic drug in preventing allergic reactions and guiding safe anesthetic management. Individualized assessment, careful interpretation of test results, and preparedness are key to ensuring patient safety in cases of suspected LA hypersensitivity.