No

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

Should be avoided in patients with uncontrolled hyperthyroidism. Should be used in minimal amounts in patients with significant cardiovascular problems (because of levonordefrin component). 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 mepivacaine. The effects below are more likely to occur after systemic administration rather than infiltration.

Cardiovascular: Myocardial effects include a decrease in contraction force as well as a decrease in electrical excitability and myocardial conduction rate resulting in bradycardia and reduction in cardiac output.

Gastrointestinal: Nausea and vomiting may occur

Hypersensitivity reactions: Extremely rare, but may be manifest as dermatologic reactions and edema at injection site. Asthmatic syndromes have occurred. Patients may exhibit hypersensitivity to bisulfites contained in local anesthetic solution to prevent oxidation of levonordefrin. In general, patients reacting to bisulfites have a history of asthma and their airways are hyper-reactive to asthmatic syndrome.

Neuromuscular & skeletal: Tremors

Psychogenic reactions: It is common to misinterpret psychogenic responses to local anesthetic injection as an allergic reaction. Intraoral injections are 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.

Due to levonordefrin component, use with tricyclic antidepressants or MAO inhibitors could result in increased pressor response; use with nonselective beta-blockers (ie, propranolol) could result in serious hypertension and reflex bradycardia

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.

Duration: 1-2.5 hours in upper jaw and 2.5-5.5 hours in lower jaw

Infiltration: 50 minutes

Inferior alveolar block: 60-75 minutes

Children <10 years: Maximum pediatric dosage must be carefully calculated on the basis of patient's weight but should not exceed 6.6 mg/kg of body weight or 180 mg of mepivacaine hydrochloride as a 2% solution with levonordefrin 1:20,000

Children >10 years and Adults:

Dental infiltration and nerve block, single site: 36 mg (1.8 mL) of mepivacaine hydrochloride as a 2% solution with levonordefrin 1:20,000

Entire oral cavity: 180 mg (9 mL) of mepivacaine hydrochloride as a 2% solution with levonordefrin 1:20,000; up to a maximum of 6.6 mg/kg of body weight but not to exceed 400 mg of mepivacaine hydrochloride per appointment. 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 numbers of dental carpules (1.8 mL) provide the indicated amounts of mepivacaine hydrochloride 2% and levonordefrin 1:20,000.

1 Cartridge:

36 mg mepivacaine 2% and 0.090 mg vasoconstrictor (levonordefrin 1:20,000)

2 Cartridges:

72 mg mepivacaine 2% and 0.180 mg vasoconstrictor (levonordefrin 1:20,000)

3 Cartridges:

108 mg mepivacaine 2% and 0.270 mg vasoconstrictor (levonordefrin 1:20,000)

4 Cartridges:

144 mg mepivacaine 2% and 0.360 mg vasoconstrictor (levonordefrin 1:20,000)

5 Cartridges:

180 mg mepivacaine 2% and 0.450 mg vasoconstrictor (levonordefrin 1:20,000)

6 Cartridges:

216 mg mepivacaine 2% and 0.540 mg vasoconstrictor (levonordefrin 1:20,000)

7 Cartridges:

252 mg mepivacaine 2% and 0.630 mg vasoconstrictor (levonordefrin 1:20,000)

8 Cartridges:

288 mg mepivacaine 2% and 0.720 mg vasoconstrictor (levonordefrin 1:20,000)

9 Cartridges:

324 mg mepivacaine 2% and 0.810 mg vasoconstrictor (levonordefrin 1:20,000)

10 Cartridges:

360 mg mepivacaine 2% and 0.900 mg vasoconstrictor (levonordefrin 1:20,000)

Note: Adult and children doses of mepivacaine hydrochloride with levonordefrin cited from USP Dispensing Information (USP DI), 17th ed, The United States Pharmacopeial Convention, Inc, Rockville, MD, 1997, 139.

No data reported

No information available to require special precautions

No effects or complications reported

Injection: Mepivacaine hydrochloride 2% with levonordefrin 1:20,000 (1.8 mL dental cartridges)

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

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

MacKenzie TA and Young ER, "Local Anesthetic Update," Anesth Prog, 1993, 40(2):29-34.

Wynn RL, "Epinephrine Interactions With Beta-Blockers," Gen Dent, 1994, 42(1):16, 18.

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

Yagiela JA, "Local Anesthetics," Anesth Prog, 1991, 38(4-5):128-41.