Which local anesthetic is best for patients with liver disease or dysfunction?

Articaine is considered advantageous for patients with liver disease or dysfunction due to its unique chemical structure and metabolic pathway. Unlike many other local anesthetics, articaine is primarily metabolized in the bloodstream by plasma esterases, which are less affected by liver function. This is particularly critical for patients with liver impairment, as their ability to metabolize drugs through hepatic pathways is compromised.

In contrast, other local anesthetics such as lidocaine and bupivacaine rely heavily on liver metabolism, which could lead to accumulation and increased risk of toxicity in patients with liver dysfunction. Mepivacaine undergoes some hepatic metabolism as well, but it is also excreted by the kidneys. Therefore, in patients with compromised liver function, the use of articaine, which minimizes hepatic metabolism and offers a safer option, is preferable. This metabolic profile allows more predictable and safer anesthetic management in this vulnerable population.