Yes

Local Anesthetic

Dental: Amide-type anesthetic used for local infiltration anesthesia; injection near nerve trunks to produce nerve block

C

Hypersensitivity to local anesthetics of the amide type

Aspirate the syringe after tissue penetration and before injection to minimize chance of direct vascular injection

Degree of adverse effects in the CNS and cardiovascular system are directly related to the blood levels of local anesthetic.

Central nervous system: High blood levels result in anxiety, restlessness, disorientation, confusion, dizziness, and seizures. This is followed by depression of CNS resulting in somnolence, unconsciousness and possible respiratory arrest. In some cases, symptoms of CNS stimulation may be absent and the primary CNS effects are somnolence and unconsciousness.

Gastrointestinal: Nausea and vomiting may occur

Hypersensitivity reactions: May manifest as dermatologic reactions and edema at injection site. Asthmatic syndromes have occurred.

Neuromuscular & skeletal: Tremors

Psychogenic reactions: It is common to misinterpret psychogenic responses to local anesthetic injection as an allergic reaction. Intraoral injection is perceived by many patients as a stressful procedure in dentistry. Common symptoms to this stress are sweating, palpitations, hyperventilation, generalized pallor and a fainting feeling.

No data reported

Local anesthetics bind selectively to the intracellular surface of sodium channels to block influx of sodium into the axon. As a result, depolarization necessary for action potential propagation and subsequent nerve function is prevented. The block at the sodium channel is reversible. When drug diffuses away from the axon, sodium channel function is restored and nerve propagation returns.

Onset of action: 30-120 seconds in upper jaw; 1-4 minutes in lower jaw

Duration: 20 minutes in upper jaw; 40 minutes in lower jaw

Serum half-life: 1.9 hours

Children <10 years: Up to 5-6 mg/kg of body weight; maximum pediatric dosage must be carefully calculated on the basis of patient's weight but must not exceed 270 mg (9 mL) of the 3% solution

Children >10 years and Adults:

Dental anesthesia, single site in upper or lower jaw: 54 mg (1.8 mL) as a 3% solution

Infiltration and nerve block of entire oral cavity: 270 mg (9 mL) as a 3% solution; up to a maximum of 6.6 mg/kg of body weight but not to exceed 300 mg per appointment. Manufacturer's maximum recommended dose is not more than 400 mg to normal healthy adults. The effective anesthetic dose varies with procedure, intensity of anesthesia needed, duration of anesthesia required, and physical condition of the patient. Always use the lowest effective dose along with careful aspiration.

The following number of dental carpules (1.8 mL) provide the indicated amounts of mepivacaine dental anesthetic 3%.

1 cartridge:

54 mg mepivacaine (3%)

2 cartridges:

108 mg mepivacaine (3%)

3 cartridges:1

162 mg mepivacaine (3%)

4 cartridges:

216 mg mepivacaine (3%)

5 cartridges :

270 mg mepivacaine (3%)

6 cartridges::

324 mg mepivacaine (3%)

7 cartridges::

378 mg mepivacaine (3%)

8 cartridges:

432 mg mepivacaine (3%)

Note: Adult and children doses of mepivacaine dental anesthetic cited from USP Dispensing Information (USP DI), 17th ed, The United States Pharmacopeial Convention, Inc, Rockville, MD, 1997, 138-9.

No data reported

No information available to require special precautions

No effects or complications reported

Injection: Mepivacaine hydrochloride 3% (1.8 mL dental cartridges)

Ayoub ST and Coleman AE, "A Review of Local Anesthetics," Gen Dent, 1992, 40(4):285-7, 289-90.

Wynn RL, "Recent Research on Mechanisms of Local Anesthetics," Gen Dent, 1995, 43(4):316-8.