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Mepivacaine

    Brands

    DEA Class; OTC, Rx

    Common Brand Names; Carbocaine, Polocaine, Polocaine-MPF

    • Local Anesthetics, Amides; 
    • Local Anesthetics, Dental; 
    • Local Anesthetics, Parenteral

    Amide type local anesthetic; not recommended for subarachnoid use; produces less vasodilation and has a more rapid onset and longer duration of action than lidocaine.

    Indicated for use as local anesthesia or regional anesthesia.

    Hypersensitivity to mepivacaine or amide anesthetics, sensitivity to parabens

    Angioneurotic edema (including laryngeal edema), syncope, depression of the myocardium, decreased cardiac output, heart block, hypotension (or sometimes hypertension), bradycardia, ventricular arrhythmias, and possibly cardiac arrest

    Excitation and/or depression, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors (possible convulsions), chills, constriction of the pupils, elevated temperature, paralysis of the of consciousness, persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities/sphincter control, headache, septic meningitis, meningismus, cranial nerve palsies due to traction on nerves from of cerebrospinal fluid

    Urticaria, pruritus, erythema, excessive sweating

    Nausea, vomiting

    Backache

    Urinary retention, fecal/urinary incontinence

    Sneezing, respiratory paralysis (secondary to spinal block)

    Loss of perineal sensation and sexual function

    Anaphylactoid-like symptomatology (including severe hypotension)

    Slowing of labor; increased incidence of forceps delivery

    Some formulations may contain sulfites

    History of malignant hyperthermia

    Monitor patient’s state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity

    DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear)

    Respiratory arrest reported with use

    Unintentional intravascular injection may result in seizures

    Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

    Risk of chondrolysis if receiving continuous intra-articular infusion following arthroscopic or other surgical procedures

    Pregnancy Category: C

    Lactation: Not known if excreted in breast milk

    NOTE: The dose of local anesthetics differs with the anesthetic procedure; the area to be anesthetized; the vascularity of the tissues; the number of neuronal segments to be blocked; the intensity of the block; the degree of muscle relaxation required; the duration of anesthesia desired; individual tolerance; and the physical condition of the patient.

    Adults

    400 mg as a single regional dose not to exceed 1000 mg/24 hours. Doses up to 7 mg/kg (550 mg) have been given without adverse effects, but these doses are not recommended except in unusual circumstances and should not be repeated at intervals < 1.5 hours. During dental procedures, the total dose should not exceed 400 mg.

    Children

    5—6 mg/kg. For children under age 3 or weighing less than 13.6 kg, use mepivacaine solutions < 2%. The maximum dose for dental procedure may be calculated using the following formula based on Clark’s rule: Maximum dose (mg) = weight (in pounds)/150 x 400 mg

    Mepivacaine Hydrochloride

    injectable solution

    • 1%
    • 1.5%
    • 2%
    • 3%