Adult Dosing
Anesthesia for dental procedures
- Dose varies depending upon the area to be anesthetized, the vascularity of the tissues, individual tolerance and the technique of anesthesia
- Upper or lower jaw: 1.7 mL (34 mg of 2% or 51 mg of 3%)
- Entire oral cavity: 180 mg of 2% or 270 mg of 3%
- Max: 3 mg/lb or 400 mg/ sitting
Note:
- Infiltration or injection should be performed slowly with frequent aspiration
Local or regional analgesia and anesthesia
- Dose varies depending upon the area to be anesthetized, the vascularity of the tissues, individual tolerance and the technique of anesthesia
- Max: 400 mg/procedure
- Cervical, brachial, intercostal, pudendal nerve block
- 1%: 5-40 mL; Total dose: 50-400 mg
- 2%: 5-20 mL; Total dose: 100-400 mg
- Transvaginal block (paracervical plus pudendal)
- 1%: up to 30 mL; Total dose: up to 300 mg
- Paracervical block
- 1%: up to 20 mL; Total dose: up to 200 mg
- Caudal and Epidural block
- 1%: 15-30 mL; Total dose: 150-300 mg
- 1.5%: 10-25 mL; Total dose: 150-375 mg
- 2%: 10-20 mL; Total dose: 200-400 mg
- Infiltration
- 1%: up to 40 mL; Total dose: up to 400 mg
- Therapeutic block (pain management)
- 1%: 1-5 mL; Total dose: 10-50 mg
- 2%: 1-5 mL; Total dose: 20-100 mg
Note:
- Do not administer repeated dose at an interval <1.5 hrs
- Discard the unused portion of solution not containing preservatives
Pediatric Dosing
Anesthesia for dental procedures
- 3 mg/lb; Max: 270 mg of 3% or 180 mg of 2%
Local or regional analgesia and anesthesia
- Children <30 lbs: 5-6 mg/kg (2.5-3 mg/lb)
Note:
- Pediatric patients <3 yrs or <30 lbs should be administer concentration <2% (i.e. 0.5-1.5%)
[Outline]
- Clinicians experienced in the diagnosis and management of dose related toxicity and other acute emergencies should only administer local anesthesia
- Oxygen, resuscitative drugs, cardiopulmonary resuscitation equipment and personnel resources needed for proper management of toxic reactions and related emergencies should be readily available, as any delay in proper management of dose related toxicity, underventilation or altered sensitivity can lead to the development of acidosis, cardiac arrest and possibly death
- Safety of local anesthetic solutions containing antimicrobial preservatives has not been established with regard to intrathecal injection, hence should not be used for epidural or caudal anesthesia
- Before injecting any local anesthetic, aspirate for blood or cerebrospinal fluid to avoid intravascular or subarachnoid injection
- Retrograde arterial flow to vital CNS areas resulting in to fatalities can occur with use of local anesthetics in the head and neck region. The practitioner should be alert to early signs of alteration in sensorium or vital signs
- Severe persistent hypertension can occur when mepivacaine with epinephrine or other vasopressors is used concomitantly with ergot-type oxytocic drugs
- Mepivacaine containing a vasoconstrictor, such as epinephrine, should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine type, also in patients with history of hypertension, arteriosclerotic heart disease, cerebral vascular insufficiency, heart block, thyrotoxicosis and diabetes, as it can result in prolonged hypertension
- Allergic reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes can occur mepivacaine 2% soln as it also contains potassium metabisulfite
- Methemoglobinemia manifested as cyanosis of the nail beds and lips, fatigue and weakness has been observed with mepivacaine, along with other local anesthetics. Administer methylene blue 1-2 mg/kg body weight over a 5 minute, if methemoglobinemia does not respond to oxygen administration
- Regarding the use of local anesthetics with vasoconstrictors in patients with ischemic heart disease the American Heart Association states that, "Vasoconstrictor agents should be used in local anesthesia solutions during dental practice only when it is clear that the procedure will be shortened or the analgesia rendered more profound. When a vasoconstrictor is indicated, extreme care should be taken to avoid intravascular injection. The minimum possible amount of vasoconstrictor should be used"
- Use lowest effective dose of anesthesia, to avoid high plasma levels and possible adverse effects. Give reduced doses to debilitated, elderly patients, acutely ill patients, and children proportionate to their weight and physical status
- Administer slowly with aspiration to avoid intravascular injection and thus systemic reaction to both local anesthetic and vasoconstrictor
- Use reduced dose when administered with sedatives, as local anesthetic agents are CNS depressants like sedatives, and may have additive effect
- Inadvertent intravascular administration or rapid absorption of mepivacaine can cause high blood level of the drug indicated as change in sensorium such as excitation, disorientation or drowsiness
- Use cautiously if there is inflammation or sepsis in the region of the proposed injection
- Administer the test dose and observe for its effect, prior to administering the full dose
- Monitor cardiovascular and respiratory vital signs carefully and constantly after each local anesthetic injection. Restlessness, anxiety, incoherent speech, lightheadedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, dizziness, blurred vision, tremors, twitching, depression, or drowsiness are the early signs of CNS toxicity
- Administer local anesthetic solutions containing a vasoconstrictor cautiously and in restricted quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply such as digits, nose, external ear and penis. Ischemic injury or necrosis can occur in hypertensive vascular diseases, due to exaggeration of vasoconstrictor response
- Prolongation of A-V conduction is produced by this drugs; patients having impaired CV function are less able to compensate for this functional changes
- Serious dose-related cardiac arrhythmias has been reported if preparations containing a vasoconstrictor such as epinephrine are used during or following the administration of potent inhalation anesthetics
- The safety and efficacy of mepivacaine depends on proper dosage, correct technique, adequate precautions, and readiness for emergencies
- Familial malignant hyperthermia can occur. Maintain standard procedures for the management of malignant hyperthermia. Temperature elevation is preceded by unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Heart Block
- Severe hypertension
- Arteriosclerotic heart disease
- Cerebral vascular insufficiency
- Thyrotoxicosis
- Diabetes
- Ischemic heart disease
- MAOI drugs use
- Tricyclic Antidepressants use
- Inflammation or sepsis
- Debilitated or elderly patients
- Compromised blood supply
- Known allergies and sensitivities
- Impaired cardiac function
Pregnancy Category:C
Breastfeeding: No studies available on the use of mepivacaine during breastfeeding. A single dose of mepivacaine during breastfeeding is unlikely to adversely affect the breastfed infant, based on low excretion of other local anesthetics into breastmilk. However while nursing a newborn or preterm infant an alternate drug may be preferred. Interferes with initial nursing behavior of some infants during the first 5 days postpartum when given as a local anesthetic to the mother during labor. More study is required to clarify the effect of mepivacaine on breastfeeding outcome when used during labor. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 May 2011. Manufacturer advises caution when mepivacaine is administered to a nursing woman.
