SCANDONEST 3 % PLAIN

Indications

• Local infiltration anesthesia
• Regional anesthesia
• Dental procedures
• Minor surgical procedures

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Local anesthetics block the generation and the conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. The order of loss of nerve function typically follows pain, temperature, touch, proprioception, and skeletal muscle tone.

Pharmacodynamics

Mepivicaine is an amide local anesthetic characterized by a reasonably rapid onset and medium duration of action. Systemic absorption can lead to minimal effects on the cardiovascular and central nervous systems, with limited changes in cardiac conduction, excitability, refractoriness, contractility, and peripheral vascular resistance at therapeutic doses.

Pharmacokinetics

Mepivacaine is absorbed systemically when used in local anesthesia, leading to effects on the cardiovascular and central nervous systems. Its pharmacokinetics involve metabolism primarily in the liver, with renal excretion of metabolites. The specific half-life and distribution can vary based on the route of administration and patient factors.

Contra-indications

• Hypersensitivity to mepivacaine or other amide local anesthetics
• Severe heart block
• Hypovolemia
• Infection at the injection site

Adverse effects

• Dizziness
• Tinnitus
• Nausea
• Vomiting
• Headache
• Allergic reactions
• Cardiovascular effects such as hypotension or arrhythmias

Interactions

• Other local anesthetics can increase the risk of toxicity
• Certain antiarrhythmics may have additive effects on cardiac conduction
• Monoamine oxidase inhibitors (MAOIs) may enhance the effects of local anesthetics

Precautions

• Use with caution in patients with hepatic impairment
• Caution in patients with cardiovascular disease
• Monitor for signs of systemic toxicity during administration
• Use with caution in pregnant patients

Pregnancy

Mepivacaine should only be used during pregnancy if the benefits outweigh the risks. Limited data is available on its safety in pregnant women.

Breast-feeding

Mepivacaine is excreted in breast milk. Caution is advised if the mother is breastfeeding.

Storage

Store at room temperature, away from light and moisture. Do not freeze.

Formulations

• Injection solution (e.g., 1%, 2% concentrations)

Indications

• Local anesthesia for minor surgical procedures
• Anaesthesia before venepuncture
• Anaesthesia for skin lesions
• Regional anesthesia techniques (e.g., for cervical curettage or debridement of leg ulcers)

Dosage

Children: Neonate: Apply up to 1 g for a maximum of 1 hour before procedure, under occlusive dressing. For children 1-2 months, the same dosage applies. Consult BNF for Children for further dosing information.

Adults: Apply up to 10 g under occlusive dressing for 30–60 minutes before the procedure. Specific dosage may vary based on the procedure and patient condition; consult BNF for detailed guidelines.

Mechanism of action

Mepivacaine exerts its effects by binding to voltage-gated sodium channels on the neuronal cell membrane, inhibiting sodium influx, which is essential for the generation and conduction of action potentials in nerve fibers. This leads to a reversible loss of sensation in the targeted area.

Pharmacodynamics

Mepivacaine provides rapid onset of anesthesia, with effects typically lasting between 1 to 3 hours depending on the mode of administration and concentration used. It is favored for its lower potential for vasodilation compared to other local anesthetics, thus providing a more prolonged effect in certain settings.

Pharmacokinetics

Mepivacaine is rapidly absorbed into the bloodstream when administered parenterally. It is metabolized primarily in the liver and excreted in the urine, with a half-life of approximately 1.5 to 2.5 hours in healthy adults. The drug's pharmacokinetics can be altered in patients with hepatic impairment, necessitating caution in such populations.

Contra-indications

• Avoid injection into infected tissues
• Avoid injection into inflamed tissues
• Severe atrio-ventricular conduction disorders not controlled by a pacemaker
• Hypersensitivity to mepivacaine or other amide local anesthetics

Adverse effects

• Arrhythmia
• Dizziness
• Hypertension
• Hypotension
• Nausea
• Paraesthesia
• Vomiting
• Neurotoxicity
• Sexual dysfunction (in adults)
• Methaemoglobinaemia
• Fever (in adults)
• Headache (in adults)
• Skin reactions

Interactions

• Antiarrhythmics
• Other local anesthetics

Precautions

• Consider dose reduction in elderly and debilitated patients
• Caution in patients with cardiovascular disease, epilepsy, hypovolaemia, impaired cardiac conduction, impaired respiratory function, and myasthenia gravis
• Increased risk of toxic plasma concentrations in patients with hepatic impairment

Pregnancy

Use with caution in early pregnancy.

Breast-feeding

Use with caution.

Storage

Store below 25°C, protect from light.

Formulations

• Mepivacaine hydrochloride cream 5% (Denela, Emla, Nulbia), containing 25 mg of lidocaine and 25 mg of prilocaine per gram

Mechanism of action

Local anesthetics block the generation and the conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. In general, the progression of anesthesia is related to the diameter, myelination, and conduction velocity of affected nerve fibers. Clinically, the order of loss of nerve function is as follows: pain, temperature, touch, proprioception, and skeletal muscle tone.

Pharmacodynamics

Mepivicaine is an amide local anesthetic. Mepivicaine as a reasonably rapid onset and medium duration and is known by the proprietary names as Carbocaine and Polocaine. Mepivicaine is used in local infiltration and regional anesthesia. Systemic absorption of local anesthetics produces effects on the cardiovascular and central nervous systems. At blood concentrations achieved with normal therapeutic doses, changes in cardiac conduction, excitability, refractoriness, contractility, and peripheral vascular resistance are minimal.