What should be used for local anesthesia in patients with novacaine allergy?

There are two types of local anesthetics: esters and amides.

Esters: procaine, tetracaine, novacaine, cocaine. Produce metabolite PABA.

Amides: lidocaine, bupivacaine. Preserved in MPB (structurally similar to PABA).

Pure amides, without MPB preservative (dental cartridge, single-dose ampules from resuscitation cart), will not cross react with esters.

Hence, in patient with history of novacaine allergy, use lidocaine without preservative from resuscitation cart.

Source

Roberts: Clinical Procedures in Emergency Medicine, 4th ed.