Which local anesthetic is contraindicated for patients with COPD?

Prilocaine is contraindicated for patients with chronic obstructive pulmonary disease (COPD) primarily due to its potential to cause methemoglobinemia, which can lead to decreased oxygen delivery in patients who already have compromised respiratory function. In patients with COPD, the ability to adequately oxygenate is already impaired, and the additional risk of methemoglobinemia could worsen their condition, leading to serious complications.

Lidocaine, bupivacaine, and mepivacaine do not carry the same risk of methemoglobinemia and are generally considered safer choices for patients with COPD, as they do not have a significant impact on oxygenation or respiratory function compared to prilocaine. Thus, choosing prilocaine for these patients can be particularly risky, aligning with the contraindication of its use in this population.