Drug reference
Infiltration anaesthesia and nerve block in dentistry ▶Child 3–17 years: Consult expert dental sources ▶Adult: Consult expert dental sources DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.
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Avoid injection into infected tissues . avoid injection into inflamed tissues. intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block. severe atrio-ventricular conduction disorders not controlled by a pacemaker CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises the local anaesthetic effect may be reduced when injected into an inflamed or infected area, due to altered local pH. Increased absorption into the blood also increases the possibility of systemic side-effects.
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Cardiovascular disease. children (consider dose reduction). debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy. hypovolaemia . impaired cardiac conduction. impaired respiratory function. myasthenia gravis. shock
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▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.
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Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.
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→Appendix 1: anaesthetics, local
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▶Common or very common Arrhythmias. dizziness. hypertension. hypotension. nausea. paraesthesia. vomiting ▶Uncommon Neurotoxicity ▶Rare or very rare Arachnoiditis. cardiac arrest. diplopia. nerve disorders. respiratory depression SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.
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Use with caution in early pregnancy.
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Use with caution.
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Manufacturer advises caution; increased risk of toxic plasma concentrations in severe impairment.
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Use with caution; increased risk of side-effects.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Scandonest plain (Septodont Ltd) Mepivacaine hydrochloride 30 mg per 1 ml Scandonest plain 3% solution for injection 2.2ml cartridges | 50 cartridge P £21.95
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Consult expert dental sources
First-line fragment. Read the complete Indications and Dose section above.
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