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Medicina Oral, Patologia Oral Y Cirugia... Nov 2020The different indications for extraction of the lower third molars, require resources to manage pain and discomfort, such as, for example, adequate anesthetic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The different indications for extraction of the lower third molars, require resources to manage pain and discomfort, such as, for example, adequate anesthetic techniques, and the type of anesthetic used can influence the management of pain in tooth extractions. Few studies in the literature compare the anesthetics 4% articaine hydrochloride and 2% mepivacaine hydrochloride showing evidence that both allow for successful pain management. This study sought to compare the volume, efficacy and safety of these two anesthetic drugs, both associated with epinephrine at a ratio of 1:100,000, used in the extraction of lower third molars.
MATERIAL AND METHODS
A controlled, clinical, split-mouth compared these both local anesthetics in a sample of 20 patients requiring bilateral extraction of teeth. Pain was the main parameter to be assessed by means of the visual analogue scale (VAS) applied during and immediately after the surgery. Hemodynamic parameters, adverse events, presence of paresthesia and satisfaction of patients and surgeon were also analysed.
RESULTS
Pain management was more effective with mepivacaine up to two hours after surgery (p=0.014), whereas the surgeon was more satisfied with the use of articaine during divulsion and suture (p<0.05). However no statistically significant differences were found between both anesthetics regarding pain perception.
CONCLUSIONS
It was observed that both anesthetics are efficient and safe in the management of pain for extraction of third molars, in which less amount of mepivacaine is needed. The satisfaction of patients and surgeon was the same for both anesthetics, with articaine being highlighted during divulsion and suture.
Topics: Anesthesia, Dental; Anesthetics, Local; Carticaine; Double-Blind Method; Humans; Mepivacaine; Molar, Third; Tooth Extraction
PubMed: 32701928
DOI: 10.4317/medoral.23780 -
Trends in Cardiovascular Medicine Jan 2010Class I cardiac antiarrhythmic drugs, for example, lidocaine, mexiletine, flecainide, quinidine, and procainamide, continue to play an important role in the therapy for... (Review)
Review
Class I cardiac antiarrhythmic drugs, for example, lidocaine, mexiletine, flecainide, quinidine, and procainamide, continue to play an important role in the therapy for cardiac arrhythmias because of the presence of use-dependent block. Lidocaine, as well as related drugs such as mepivacaine, bupivacaine, and cocaine, also belong to the class of medications referred to as local anesthetics. In this review, we will consider lidocaine as the prototypical antiarrhythmic drug because it continues to be widely used both as an antiarrhythmic drug (first used as an antiarrhythmic drug in 1950) as well as a local anesthetic agent. Both of these clinical uses depend upon block of sodium current (I(Na)), but it is the presence of use-dependent I(Na) block, that is, an increasing amount of block at faster heart rates, which enables a local anesthetic agent to be a useful antiarrhythmic drug. Although many early studies investigated the action of antiarrhythmic drugs on Na currents, the availability of site-directed mutant Na channels has enabled for major advances in understanding their mechanisms of action based upon molecular conformations of the Na channel.
Topics: Animals; Anti-Arrhythmia Agents; Humans; Ion Channel Gating; Lidocaine; Models, Molecular; Molecular Structure; Mutagenesis, Site-Directed; Protein Conformation; Sodium; Sodium Channel Blockers; Sodium Channels; Structure-Activity Relationship
PubMed: 20685573
DOI: 10.1016/j.tcm.2010.03.002 -
British Journal of Anaesthesia Sep 1991Mepivacaine and bupivacaine are used clinically as racemic mixtures of enantiomers. In these studies the enantiomers of each agent were administered separately to sheep...
Mepivacaine and bupivacaine are used clinically as racemic mixtures of enantiomers. In these studies the enantiomers of each agent were administered separately to sheep by i.v. bolus injection on separate occasions. Enantioselective disposition was deemed if the R:S ratio of the relevant pharmacokinetic parameter differed significantly from unity. Both enantiomers of both agents were cleared principally by the liver; urinary excretion of unmetabolized agents accounted for less than 2% of the doses. For R(-)-and S(+)-mepivacaine, respective mean (SEM) values of parameters were: total body clearance 1.20 (0.29) litre min-1 and 0.97 (0.20) litre min-1 (ns); total volume of distribution 144 (39) litre and 80 (21) litre (P less than 0.05); slow half-life 120 (40) min and 84 (22) min (ns); mean hepatic extraction ratio 0.50 (0.14) and 0.52 (0.09) (ns); mean hepatic clearance 0.75 (0.23) litre min-1 and 0.75 (0.18) litre min-1 (ns). For R(+)- and S(-)-bupivacaine, respective values were: total body clearance 0.77 (0.33) litre min-1 and 0.53 (0.26) litre min-1 (P less than 0.05); total volume of distribution 40 (10) litre and 43 (10) litre (ns); slow half-life 57 (10) min and 104 (21) min (P less than 0.05); mean hepatic extraction ratio 0.46 (0.15) and 0.29 (0.13) (P less than 0.05); mean hepatic clearance 0.85 (0.31) litre min-1 and 0.54 (0.26) litre min-1 (P less than 0.05). Thus there was enantioselective distribution of mepivacaine and enantioselective clearance of bupivacaine, but the magnitude of the effect was relatively small.
Topics: Animals; Bupivacaine; Cardiac Output; Female; Half-Life; Heart Atria; Injections; Liver; Mepivacaine; Metabolic Clearance Rate; Sheep; Stereoisomerism
PubMed: 1911009
DOI: 10.1093/bja/67.3.239 -
Iranian Journal of Medical Sciences Sep 2020The use of amide-based local anesthetics is generally considered to be safe. However, the literature on their safety in patients with hepatic injury is scarce. For the...
BACKGROUND
The use of amide-based local anesthetics is generally considered to be safe. However, the literature on their safety in patients with hepatic injury is scarce. For the first time, the present study aimed to evaluate the effect and safety of five commonly used amide-based local anesthetics in the setting of hepatic failure.
METHODS
A total of 96 Sprague-Dawley rats were studied from September 2015 to September 2016 in the Animal Laboratory Center, Shiraz University of Medical Sciences, Shiraz, Iran. They divided into three groups, namely a control, induced liver failure (LF), and non-LF groups. The rats were administered local anesthetic agents (lidocaine, prilocaine with felypressin, lidocaine with epinephrine, mepivacaine, articaine, and prilocaine). The effect of these drugs was evaluated by comparing the liver enzyme levels of the rats. The data were analyzed using SPSS software. The independent test, one-way ANOVA, and the tests were used to compare groups. A P<0.05 was considered statistically significant.
RESULTS
In non-LF rats, mepivacaine, lidocaine, and lidocaine with epinephrine caused a significant increase in aspartate aminotransferase (AST) level compared with the effect of prilocaine with felypressin and articaine. In non-LF rats, only mepivacaine resulted in a significant increase in AST level compared with lidocaine (P=0.007) and prilocaine with felypressin (P=0.044). In this group, only mepivacaine caused a significant increase in alanine transaminase (ALT) level compared with lidocaine (P=0.016). Whereas in the LF group, mepivacaine caused an increase in ALT level compared with the effect of both prilocaine with felypressin (P=0.009) and articaine (P<0.001). The use of mepivacaine in the LF group caused a significant increase in gamma-glutamyl transpeptidase level compared prilocaine with felypressin (P=0.039).
CONCLUSION
Articaine and prilocaine with felypressin local anesthetics induced the least change in hepatic enzyme levels in rats with abnormal hepatic function.
PubMed: 33060881
DOI: 10.30476/ijms.2020.72596.0 -
European Journal of Dentistry 2015To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with...
Comparison of speed of action and injection discomfort of 4% articaine and 2% mepivacaine for pulpal anesthesia in mandibular teeth: A randomized, double-blind cross-over trial.
OBJECTIVE
To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 in securing mandibular first molar pulp anesthesia.
MATERIALS AND METHODS
Totally, 25 patients were recruited in a crossover, randomized, double-blind study. Each subject received injections of mepivacaine 2% with epinephrine 1:100,000 as inferior alveolar nerve block (IANB) supplemented with either articaine 4% with epinephrine 1:100,000 (septocaine) or mepivacaine 2% buccal infiltration (BI) injection on two visits. The time of first numbness to associated lip, tongue and tooth was recorded by asking the participant directly and using electrical pulp tester. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation. The patients rated the pain of infiltration using a 100 mm visual analog scale immediately after receiving each injection. The pain scores were compared using the paired t-test.
RESULTS
There were significant differences in the meantime of first numbness to associated lip and tooth of volunteers between mepivacaine and articaine BI groups P = 0.03 and 0.002. Volunteers in articaine group recorded earlier lip and teeth numbness than those in mepivacaine group. There were significant differences between the mean pain scores for volunteers in the post IANB and postbuccal injection groups (t-test: P <0.001). Mepivacaine IANB injection was significantly more painful than articaine/mepivacaine buccal injection.
CONCLUSIONS
About 4% articaine was faster than 2% mepivacaine (both with 1:100,000 adrenaline) in anesthetizing the pulps of lower molar teeth after BIs. Earlier lip and teeth numbness were recorded in articaine group. Articaine and mepivacaine BIs were more comfortable than mepivacaine IANB injections.
PubMed: 26038650
DOI: 10.4103/1305-7456.156811 -
Dental Research Journal 2023This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two...
Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial.
BACKGROUND
This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.
MATERIALS AND METHODS
The current randomized controlled clinical trial was conducted on 100 patients in two groups ( = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and < 0.05 was set as statistically significant.
RESULTS
The patients' pain severities during the three stages were significantly different ( = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.
CONCLUSION
The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.
PubMed: 37180689
DOI: No ID Found -
Anesthesiology Aug 1973
Review
Topics: Acetates; Anesthetics; Animals; Atropine; Biotransformation; Carbon Tetrachloride; Chloroform; Diazepam; Drug Interactions; Ethers; Fentanyl; Halothane; Humans; Lidocaine; Liver; Lung; Mepivacaine; Methoxyflurane; Oxazepam; Pharmacogenetics
PubMed: 4146380
DOI: 10.1097/00000542-197308000-00004 -
International Journal of Molecular... Aug 2020Acidic environments, such as in inflamed tissues, favor the charged form of local anesthetics (LA). Hence, these drugs show less cell permeation and diminished potency....
Acidic environments, such as in inflamed tissues, favor the charged form of local anesthetics (LA). Hence, these drugs show less cell permeation and diminished potency. Since the analgesic capsaicin (CAP) triggers opening of the TRPV1 receptor pore, its combination with LAs could result in better uptake and improved anesthesia. We tested the above hypothesis and report here for the first time the analgesia effect of a two-drug combination (LA and CAP) on an inflamed tissue. First, CAP solubility increased up to 20 times with hydroxypropyl-beta-cyclodextrin (HP-β-CD), as shown by the phase solubility study. The resulting complex (HP-β-CD-CAP) showed 1:1 stoichiometry and high association constant, according to phase-solubility diagrams and isothermal titration calorimetry data. The inclusion complex formation was also confirmed and characterized by differential scanning calorimetry (DSC), X-ray diffraction, and H-NMR. The freeze-dried complex showed physicochemical stability for at least 12 months. To test in vivo performance, we used a pain model based on mouse paw edema. Results showed that 2% mepivacaine injection failed to anesthetize mice inflamed paw, but its combination with complexed CAP resulted in pain control up to 45 min. These promising results encourages deeper research of CAP as an adjuvant for anesthesia in inflamed tissues and cyclodextrin as a solubilizing agent for targeting molecules in drug delivery.
Topics: 2-Hydroxypropyl-beta-cyclodextrin; Anesthesia, Local; Anesthetics, Local; Animals; Calorimetry, Differential Scanning; Capsaicin; Carrageenan; Disease Models, Animal; Drug Compounding; Drug Stability; Drug Therapy, Combination; Excipients; Hyperalgesia; Inflammation; Magnetic Resonance Spectroscopy; Male; Mepivacaine; Mice; Microscopy, Electron, Scanning; Pain; Pain Management; Solubility; X-Ray Diffraction
PubMed: 32785200
DOI: 10.3390/ijms21165741 -
JA Clinical Reports Oct 2020In single-space combined spinal-epidural anesthesia (CSEA), it is important to correctly determine if the fluid coming out of the spinal needle is cerebrospinal fluid...
INTRODUCTION
In single-space combined spinal-epidural anesthesia (CSEA), it is important to correctly determine if the fluid coming out of the spinal needle is cerebrospinal fluid (CSF) or the liquid used in the loss of resistance (LOR) technique. In this study, we used mepivacaine for LOR and measured the pH values of CSF and mepivacaine to determine whether the pH test is a reliable method to confirm CSF when performing single-space CSEA.
METHODS
This clinical trial included 47 full-term pregnant women who underwent cesarean section. Single-space CSEA was administered at the lumbar intervertebral space using a small amount of mepivacaine for LOR. The pH values of CSF and mepivacaine were determined by the color of the test strip immediately after dropping. The area under the curve (AUC) for the pH values was calculated to determine the cutoff value for distinguishing between CSF and mepivacaine.
RESULTS
The median pH values were 7.7 (7.1-8.0) and 6.2 (5.9-6.8) for CSF and mepivacaine, respectively. When the cutoff value of pH for distinguishing CSF from mepivacaine was 7.1 or greater, the AUC was 1.0 (100% sensitivity and specificity). Our result demonstrated that CSF can be correctly distinguished from mepivacaine in patients undergoing cesarean section under single-space CSEA using a cutoff value of pH 7.1.
CONCLUSION
The pH test is a simple and reliable method to confirm CSF when performing single-space CSEA with mepivacaine for LOR.
TRIAL REGISTRATION
Accuracy of pH test paper for cerebrospinal fluid during spinal anesthesia: prospective study in healthy pregnant women under scheduled caesarean section; University Hospital Medical Information Network, UMIN000036454 . Registered 1 May 2019.
PubMed: 33009603
DOI: 10.1186/s40981-020-00383-y -
American Journal of Veterinary Research Jun 2020To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2%...
OBJECTIVE
To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2% lidocaine, 2% mepivacaine, lactated Ringer solution (LRS), or 0.1% methyl parahydroxybenzoate.
ANIMALS
17 adult horses.
PROCEDURES
In the first of 2 experiments, the left middle carpal joint (MCJ) of each of 12 horses was injected with 10 mL of 2% lidocaine (n = 3), 2% mepivacaine (3), or LRS (control; 6). After a 4-week washout period, the right MCJ of the horses that received lidocaine or mepivacaine was injected with 10 mL of LRS, and the right MCJ of horses that received LRS was injected with 10 mL of 2% lidocaine (n = 3) or 2% mepivacaine (3). In experiment 2, the left MCJ of each of 5 horses was injected with 10 mL of 0.1% methyl parahydroxybenzoate. After a 48-hour washout period, the right MCJ of each horse was injected with 10 mL of LRS. Synovial fluid (SF) samples were aseptically collected before and at predetermined times after each injection. Synovial fluid WBC count, neutrophil percentage, and total protein, neutrophil myeloperoxidase, neutrophil elastase, and Coll2-1 concentrations were compared among treatments.
RESULTS
Both lidocaine and mepivacaine induced SF changes indicative of inflammation and a catabolic collagen response, but the magnitude of those changes was more pronounced for lidocaine. Methyl parahydroxybenzoate did not cause any SF changes indicative of inflammation.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that mepivacaine was safer than lidocaine for intra-articular injection in horses.
Topics: Animals; Biomarkers; Horse Diseases; Horses; Injections, Intra-Articular; Lidocaine; Mepivacaine; Synovial Fluid
PubMed: 32436793
DOI: 10.2460/ajvr.81.6.479