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The Role of Temperature in the Action of Mepivacaine
Nikolaos DabarakisDDS, PhD,
Anastasios TsirlisDDS, PhD,
Nikolaos ParisisDDS, PhD, and
Dimitrios TsoukalasDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 53: Issue 3
Online Publication Date: Jan 01, 2006
DOI: 10.2344/0003-3006(2006)53[91:TROTIT]2.0.CO;2
Page Range: 91 – 94

increase in temperature from 20°C to 30°C, and enhancement of the local anesthetic effects was also produced by a decrease in temperature to 5°C. 5 Temperature may thus be an interesting physical variable in the study of nerve-blocking mechanisms. Given the absence in the dental literature of studies about the implications of temperature in the action of local anesthetics, the purpose of this preliminary study is to investigate the effects on the onset and the duration of pulpal anesthesia caused by lowering the temperature of the injected plain 3% mepivacaine from 20°C

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A Prospective, Randomized, Double-Blind Comparison of 2% Mepivacaine With 1 : 20,000 Levonordefrin Versus 2% Lidocaine With 1 : 100,000 Epinephrine for Maxillary Infiltrations
Ingrid LawatyDMD,
Melissa DrumDDS, MS,
Al ReaderDDS, MS, and
John NussteinDDS, MS
Article Category: Research Article
Volume/Issue: Volume 57: Issue 4
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.4.139
Page Range: 139 – 144

Maxillary infiltration anesthesia is a common method to anesthetize maxillary teeth. A number of studies 1 – 5 have evaluated mepivacaine with epinephrine or levonordefrin in operative dentistry and for surgical procedures. However, electric pulp testing was not performed to evaluate pulpal anesthesia. Hinkley et al, 6 in an experimental study of pulpal anesthesia, have shown that 2% mepivacaine with 1 : 20,000 levonordefrin is equivalent to 2% lidocaine with 1 : 100,000 epinephrine for an inferior alveolar nerve block. Because anesthesia

; The frequency (percentage) of patients regarding tooth position, day period when surgery was performed, gender, and rescue medication intake for the lidocaine and mepivacaine groups. * indicates statistically significant.
Joao Paulo Steffens,
Márcia Thaís Pochapski,
Fábio André Santos, and
Gibson Luiz Pilatti
Efficacy of Anesthetic Agents to Delay Pain Onset After Periodontal Surgery
Joao Paulo SteffensDDS, MSc,
Márcia Thaís Pochapski DDS, MSc, PhD,
Fábio André SantosDDS, MSc, PhD, and
Gibson Luiz PilattiDDS, MSc, PhD
Article Category: Research Article
Volume/Issue: Volume 58: Issue 2
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.2.57
Page Range: 57 – 60

vasoconstrictors, such as epinephrine and norepinephrine. Two percent lidocaine with 1 ∶ 100,000 epinephrine is considered a standard for comparisons with new agents. 5 Mepivacaine is considered an important anesthetic agent for its minimal vasodilating properties and being capable of promoting profound local anesthesia. On the other hand, mepivacaine without vasoconstrictor produces a short period soft tissue anesthesia. 5 For this reason, mepivacaine can be found associated with norepinephrine, an adrenergic vasoconstrictor that presents 25% of epinephrine potency, is

Figure 2. ; Anesthetic efficacy. Paired statistical analysis showed significant statistical difference between each of the anesthetics; LE and MP (P = .0016), MP and KNS (P = .0143), and LE and KNS (P < .0001). KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.
Scott Thayer,
Janice A. Townsend,
Mathilde Peters,
Qingzhao Yu,
Mark Odom, and
Kent A. Sabey
<bold>Figure 2.</bold>
Figure 2.

Anesthetic efficacy. Paired statistical analysis showed significant statistical difference between each of the anesthetics; LE and MP (P = .0016), MP and KNS (P = .0143), and LE and KNS (P < .0001). KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.

Figure 1. ; Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.
Daniel E. Becker
<bold>Figure 1.</bold>
Figure 1.

Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.

Figure 6.; Managing patients allergic to local anesthetics. Rule out common reactions misinterpreted as allergy, eg, syncope and tachycardia. Then establish that the nature of their reaction at least resembled a hypersensitivity reaction, eg, rash, pruritus, urticaria, or dyspnea. If the drug is known, choose another amide, free of vasopressor so no sulfites are present. Otherwise refer the patient to an allergist, for testing of sulfites and exemplary local anesthetics such as lidocaine, mepivacaine, and prilocaine. (Adapted from deShazo and Kemp.13)
Daniel E Becker and
Kenneth L Reed
Figure 6.
Figure 6.

Managing patients allergic to local anesthetics. Rule out common reactions misinterpreted as allergy, eg, syncope and tachycardia. Then establish that the nature of their reaction at least resembled a hypersensitivity reaction, eg, rash, pruritus, urticaria, or dyspnea. If the drug is known, choose another amide, free of vasopressor so no sulfites are present. Otherwise refer the patient to an allergist, for testing of sulfites and exemplary local anesthetics such as lidocaine, mepivacaine, and prilocaine. (Adapted from deShazo and Kemp.13)

Figure 4. ; Preference for traditional injections vs intranasal. Percentage (%) of participants who preferred traditional injections compared with intranasal administration when each test anesthetic was given. Paired statistical analysis showed no significant difference in preference comparing LE to MP (P = .8383), whereas there was a significant difference comparing LE to KNS (P = .0143) and MP to KNS (P = .0108). *P < .05. KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.
Scott Thayer,
Janice A. Townsend,
Mathilde Peters,
Qingzhao Yu,
Mark Odom, and
Kent A. Sabey
<bold>Figure 4.</bold>
Figure 4.

Preference for traditional injections vs intranasal. Percentage (%) of participants who preferred traditional injections compared with intranasal administration when each test anesthetic was given. Paired statistical analysis showed no significant difference in preference comparing LE to MP (P = .8383), whereas there was a significant difference comparing LE to KNS (P = .0143) and MP to KNS (P = .0108). *P < .05. KNS, Kovanaze; LE, 2% lidocaine with 1:100,000 epinephrine; MP, 3% mepivacaine plain.

Figure 1; Incidence of maxillary central incisor pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.
Ingrid Lawaty,
Melissa Drum,
Al Reader, and
John Nusstein
Figure 1
Figure 1

Incidence of maxillary central incisor pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.

Figure 2; Incidence of maxillary first molar pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.
Ingrid Lawaty,
Melissa Drum,
Al Reader, and
John Nusstein
Figure 2
Figure 2

Incidence of maxillary first molar pulpal anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80 readings), at each postinjection time interval, for the 2 anesthetic formulations. There were no significant differences (P < .05) between the solutions.