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General Dentistry 2014The use of mepivacaine in dentistry has remained strong since its introduction in the 1960s. It has retained its place as a valuable local anesthetic, either as a... (Review)
Review
The use of mepivacaine in dentistry has remained strong since its introduction in the 1960s. It has retained its place as a valuable local anesthetic, either as a primary agent or as an alternative to lidocaine or articaine. Mepivacaine is commonly used in medically compromised patients--for whom elevations in blood pressure or heart rate are not advisable--in a formulation with a vasoconstrictor, or in pediatric populations in a formulation without a vasoconstrictor. Pharmacologically, these are the 2 groups most susceptible to side effects and toxicity, thus mepivacaine is commonly indicated. Most often the decision to use mepivacaine is based on its vasoconstrictor effect or lack thereof (depending on the formulation). However, the pharmacokinetics of mepivacaine are not well understood or assumed to be similar to that of other local anesthetics. It is important to understand the unique pharmacologic characteristics of mepivacaine in order to minimize the potential for inadvertent toxicity.
Topics: Anesthetics, Local; Dental Health Services; Humans; Mepivacaine
PubMed: 25369391
DOI: No ID Found -
Equine Veterinary Journal Nov 2020In horses undergoing castration, direct comparison of intratesticular lidocaine vs mepivacaine as analgesic adjuncts has not yet been analysed.
BACKGROUND
In horses undergoing castration, direct comparison of intratesticular lidocaine vs mepivacaine as analgesic adjuncts has not yet been analysed.
OBJECTIVE
To compare the effects of intratesticular lidocaine and mepivacaine during equine castration using the Henderson drill under total intravenous anesthesia.
STUDY DESIGN
Randomised, double-blinded clinical study.
METHODS
Thirty-four stallions were anaesthetised using xylazine-ketamine and randomly selected to receive 10 mL either lidocaine or mepivacaine injected into each testicle. Both surgeon and anaesthetist were blinded to the selected treatment. A total of 5 minutes were required to pass between injection and first incision. Routine castration using a Henderson drill was performed. Heart rate, respiratory rate and SpO were serially recorded. Total surgical time, time prior to clamping of each testicle and time to second incision were recorded. Cremaster muscle relaxation, surgical quality scores, number of additional ketamine boluses, recovery time and recovery quality were assessed between groups.
RESULTS
Cremaster relaxation scores were significantly better for the mepivacaine group over the lidocaine group on a 1-3 scoring system (1 being most relaxed, 3 being least). The average cremaster relaxation score on both testicles treated with mepivacaine was 1 compared to the lidocaine treatment averaging 2 [P = .03 first testicle; P = .04 second testicle]. The lidocaine group had an increased number of horses requiring additional ketamine (25% of horses) compared to the mepivacaine group (16% of horses). No other significant differences were observed between the groups.
MAIN LIMITATIONS
The use of only one injection method and lack of post-operative pain scoring limit the conclusions that can be drawn from these results.
CONCLUSION
Intratesticular mepivacaine when compared with intratesticular lidocaine results in improved cremaster muscle relaxation when only waiting five min prior to the start of the procedure.
Topics: Anesthetics, Local; Animals; Equidae; Horses; Lidocaine; Male; Mepivacaine; Orchiectomy
PubMed: 32090383
DOI: 10.1111/evj.13250 -
Archives of Gynecology and Obstetrics Feb 2019After an obstetric trauma, a non-negligible number of postpartum women complain of perineal pain and dyspareunia. These symptoms clearly diminish their quality of life.... (Review)
Review
Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth.
OBJECTIVE
After an obstetric trauma, a non-negligible number of postpartum women complain of perineal pain and dyspareunia. These symptoms clearly diminish their quality of life. Many treatment options have been suggested, such as oral analgesia, local anaesthetic, or steroid injections… Regretfully, none of these have yet demonstrated their efficacy with the validated trials. The objective of this review is to retrospectively evaluate the response to vaginal infiltrations into the trigger points (where the vaginal/perineal examination sets off the maximum intensity of pain) combining local anaesthetic and corticosteroids.
METHODS
Our goal is to detect women who complain of sexual disfunction and perineal pain 2 and 6 months after childbirth. All reviewed cases correspond to vaginal deliveries made between June 2016 and April 2017. Trigger points were detected through a vaginal examination. Patients with moderate-to-severe perineal pain were determined using a visual analogue score (VAS 0-10). We suggested a treatment of vaginal infiltration specifically into the trigger points. Patients underwent local injections with a combination of mepivacaine hydrochloride 2% (8 ml) and betamethasone acetate (2 ml).
RESULTS
Twenty-seven women were treated with vaginal injections directly into the trigger points. Seven of them [7/27 (25.92%)] were treated 2 months after delivery and experienced complete recovery of their perineal pain 4 months after the treatment. Those who first chose conservative treatment [20/27 (74.08%)] were also assessed 6 months after giving birth. This group continued to suffer the same symptoms and they then subsequently underwent vaginal injections. As well as the first group, these women experienced complete recovery of their perineal pain after treatment. No side effects have been registered so far.
CONCLUSION
Women treated with vaginal injection into the trigger points improved in a fast and effective way. It seems to be a well-tolerated and safe option for women with moderate-to-severe pain.
Topics: Adult; Anesthetics, Local; Dyspareunia; Female; Humans; Mepivacaine; Pelvic Pain; Perineum; Postpartum Period; Pregnancy; Retrospective Studies; Steroids; Vagina; Young Adult
PubMed: 30542792
DOI: 10.1007/s00404-018-5000-5 -
Minerva Anestesiologica Sep 2001Many local anaesthetics are presently available for clinical use. The choice of a particular agent for a particular regional anaesthetic is based mainly on its clinical... (Review)
Review
Many local anaesthetics are presently available for clinical use. The choice of a particular agent for a particular regional anaesthetic is based mainly on its clinical and pharmacological features. Besides these, safety of drugs and the knowledge of side effects associated with their use can play a major role, since serious complications can be related to local anaesthetics administration. Pharmacologic features of mepivacaine are: its amide structure (therefore it is not detoxified by circulating plasma esterases), its rapid metabolism, which take place into the liver, and its rapid excretion via the kidneys. Clinically, mepivacaine shows: short onset time, very close to lidocaine, intermediate duration and low toxicity. Mepivacaine can be therefore considered as a first choice agent for peripheral nerve blocks, particularly in high cardiac risk patients.
Topics: Anesthetics, Local; Humans; Mepivacaine
PubMed: 11778086
DOI: No ID Found -
Australian Dental Journal Dec 2016Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal doses of mepivacaine does not lead to toxic levels of this drug in blood. This study evaluated the plasma levels of mepivacaine in third molars surgeries.
METHODS
Twenty-one patients were randomly assigned into two groups: group I (two unilateral third molars; submaximal dose of mepivacaine 108 mg with epinephrine 54 μg) and group II (four third molars; submaximal dose of mepivacaine 216 mg with epinephrine 108 μg). Blood samples were collected before anaesthesia, and 5, 10, 15, 20, 30, 40, 60, 90 and 120 min after anaesthesia.
RESULTS
Individual peak plasma concentrations ranged 0.77-8.31 μg/mL (group I) and from 2.36-7.72 μg/mL (group II). An increase in the average dose of mepivacaine from 1.88 ± 0.12 mg/kg (group I) to 3.35 ± 0.17 mg/kg (group II) increased the mean mepivacaine peak plasma levels from 2.33 ± 0.58 to 4.01 ± 0.69 μg/mL, respectively. Four patients obtained plasma levels of mepivacaine above the threshold for toxicity (5 μg/mL).
CONCLUSIONS
Toxic levels of mepivacaine are possible, even when a submaximal dose is used. A twofold increase in the dose of mepivacaine caused the mean peak plasma concentration to increase proportionally, indicating that they may be predicted based on the relation of dose per bodyweight.
Topics: Adolescent; Adult; Anesthesia, Dental; Anesthetics, Local; Dose-Response Relationship, Drug; Epinephrine; Female; Heart Rate; Humans; Injections; Male; Mepivacaine; Molar, Third; Young Adult
PubMed: 26780408
DOI: 10.1111/adj.12410 -
American Journal of Veterinary Research May 2023This study aims to assess intrathecal mepivacaine for euthanasia in anesthetized horses and compare it to a traditional euthanasia method using a single intravenous...
OBJECTIVES
This study aims to assess intrathecal mepivacaine for euthanasia in anesthetized horses and compare it to a traditional euthanasia method using a single intravenous injection of pentobarbital in sedated horses.
ANIMALS
Client-owned horses and horses requiring euthanasia due to involvement in concurrent research projects were used. Horses were randomly assigned to 1 of 2 groups: intrathecal mepivacaine after anesthesia or intravenous pentobarbital after sedation. All horses had normal vital parameters and no signs of infectious disease at the time of euthanasia.
PROCEDURES
The intrathecal mepivacaine group was anesthetized before the intrathecal injection of mepivacaine. The pentobarbital group was sedated, concurrently anesthetized and euthanized using intravenous pentobarbital, then received an intrathecal saline (0.9% NaCl) solution injection to a blind observer. Both groups were sedated with detomidine and the time from sedation to the cessation of vital parameters (respirations, pulse, corneal reflex, and ECG) was recorded. Euthanasias were recorded for review by a blinded anesthesiologist, using an independent scale to assess the quality of sedation, anesthesia induction, and lateral recumbency.
RESULTS
Time from detomidine administration to cessation of each vital parameter was significantly longer in the intrathecal mepivacaine group. There was no statistically significant difference in qualitative scores between groups for sedation or induction, but lateral recumbency was subjectively superior in the anesthetized intrathecal mepivacaine group.
CLINICAL RELEVANCE
Intrathecal mepivacaine provided a safe, effective, alternative method of euthanasia to intravenous pentobarbital and addresses concerns about barbiturate availability. This study also informs practitioners of what to expect (ie, longer cessation of vital parameters) when using the intrathecal mepivacaine method.
Topics: Horses; Animals; Pentobarbital; Mepivacaine; Euthanasia, Animal; Anesthesia, General; Administration, Intravenous
PubMed: 36921025
DOI: 10.2460/ajvr.22.11.0201 -
Italian Journal of Dermatology and... Dec 2021
Topics: Dermatitis, Allergic Contact; Humans; Lidocaine; Mepivacaine; Prilocaine
PubMed: 31487978
DOI: 10.23736/S2784-8671.19.06419-8 -
Mississippi Dental Association Journal 1975
Topics: Anesthesia, Dental; Child; Humans; Mepivacaine; Pediatric Dentistry
PubMed: 142901
DOI: No ID Found -
Journal of Investigational Allergology... 2011
Topics: Anesthetics, Local; Drug Hypersensitivity; Female; Humans; Mepivacaine; Middle Aged; Skin Tests
PubMed: 21995186
DOI: No ID Found -
The Journal of Allergy and Clinical... Apr 2008
Topics: Adult; Anaphylaxis; Anesthetics, Local; Female; Humans; Immunoglobulin E; Mepivacaine
PubMed: 18234312
DOI: 10.1016/j.jaci.2007.12.1154