Mepivacaine
Mechanism :
Mepivacaine is an amide local anesthetic similar to lidocaine. 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.
Indication :
- Dental anesthesia
- Local or regional anesthesia
Contraindications :
Not for use in spinal anesthesia.
Dosing :
Local or regional anaesthesia (egg, epidural, caudal, or peripheral nerve blocks):
Maximum single or total dose given for one procedure: 5 to 6 mg/kg; only concentrations <2% should be used in children <3 years or <14 kg.
Dental anesthesia: Children and Adolescents:
Maximum dosage must be carefully calculated on the basis of patient’s weight. Manufacturer recommends a maximum dose of 6.6 mg/kg but must not exceed 270 mg as a 3% solution.
Adverse Effect :
Directly related to the blood levels of mepivacaine, route of administration, and physical status of the patient. Effects below are more likely to occur after systemic administration rather than infiltration.
Bradycardia, cardiac insufficiency, cardiovascular depression, cardiovascular stimulation, heart block, hypertension, hypotension, low cardiac output, syncope, tachycardia, ventricular arrhythmia, Anxiety, chills, confusion, convulsions, dizziness, drowsiness, excitement, loss of consciousness, increased body temperature, nervousness, paralysis, persistent anesthesia, restlessness, Diaphoresis, erythema, pruritus, urticarial, Methemoglobinemia, Anaphylactoid reaction, angioedema, hypersensitivity reaction.
Interaction :
Beta-Blockers: May increase the serum concentration of Mepivacaine. Risk C: Monitor therapy.
Bupivacaine (Liposomal): Local Anesthetics may enhance the adverse/toxic effect of Bupivacaine (Liposomal). Management: Liposomal bupivacaine should not be administered with local anesthetics.
Neuromuscular-Blocking Agents: Local Anesthetics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents.
Hepatic Dose :
Use with caution as patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.