Mepivacaine 44mg/2.2ml / Adrenaline (base) 22micrograms/2.2ml (1 in 100,000) solution for injection cartridges

Inferior alveolar nerve block (IANB) as an anesthetic strategy has shown conflicting results in terms of efficacy in the treatment of patients with irreversible pulpitis. Mepivacaine and articaine are anesthetic agents commonly used in the IANB technique for pulpal anesthesia. This review aimed to compare mepivacaine and articaine regarding pain and success rate. We conducted a search on the databases PubMed, Scopus, Web of Science (WOS), and Cochrane Central for randomized controlled trials (RCTs) assessing mepivacaine versus articaine until September 2024. The primary outcome of interest was success rate, while the secondary outcomes were pain intensity assessed by a 10-point visual analog scale (VAS) and incidence of severe pain. Data were pooled as odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) in a random-effect model using STATA. Five RCTs including 568 patients were included in the final analysis. While there was no significant difference between the two studied groups regarding the success rate (OR: 0.92, 95% CI: 0.69 to 1.21, p=0.54), articaine significantly reduced the pain intensity compared to mepivacaine (MD: 0.59, 95% CI: 0.31 to 0.86], p<0.001). Moreover, no significant difference was observed regarding the incidence of severe pain. Articaine reduced the intensity of pain post-procedure, with comparable results regarding success rate and incidence of severe pain with mepivacaine. Further large-volume RCTs are warranted to study the differences between the two options in the long term.

Abstract licence: CC BY

ObjectiveThis meta-analysis assessed the efficacy of various anesthetic protocols for symptomatic irreversible pulpitis, comparing techniques and agents to identify the optimal anesthesia approach.MethodsWe conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases up to July 10, 2025, identifying relevant studies based on predefined inclusion and exclusion criteria. The primary outcome was the success rate of anesthesia. Data extraction and quality assessment were performed using a pre-designed form and the revised Cochrane Risk of Bias Tool. A fixed-effect model was used for meta-analysis when heterogeneity was low (I 2 ≤ 50%, p ≥ 0.1); otherwise, a random-effects model was adopted. Additionally, another model was employed for validation, and the results from both models were compared to derive more reasonable conclusions. Publication bias was assessed using funnel plots and the Egger test.ResultsFourteen RCTs were included in the meta-analysis. Pooled analysis showed that modified anesthetic protocols for SIP were 3.62 times more successful than conventional inferior alveolar nerve block (IANB) using standard 2% lidocaine with epinephrine (OR = 3.34; 95% CI: 2.49-4.48). Studies conducted in Iran had the highest success rate (OR = 4.31; 95% CI: 3.59-5.17, p p p ConclusionThis meta-analysis assessed the efficacy of various anesthetic protocols for SIP, comparing techniques and agents to identify the optimal anesthesia approach.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO database CRD42025638427.

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BackgroundIn dentistry, local anesthetic is frequently used to manage pain throughout several phases of dental treatments, including tooth extraction. The study aimed to compare the effectiveness of two techniques for controlling pain during mandibular exodontia (tooth extraction), specifically focusing on the pain experienced during injection and extraction of mandibular anterior and premolars teeth. The two techniques being compared are the intraligamentary injection technique (ILI) and the incisive nerve block technique (INB).Materials and methodsIn this study, 100 mandibular anterior and premolars and teeth that were indicated for extraction were included. The effectiveness of the two local anaesthesia techniques, intraligamentary injection technique (ILI) and incisive nerve block (INB), were compared using Modified Dental Anxiety Scale for Dental Extraction Procedure (MDAS-DEP) and visual analogue scale (VAS) during the injection and extraction stages of the procedure.ResultsA total of 100 participants (42 females, 58 males) with a mean age of 50.97 ± 11.59 years took part in the study. The mean VAS score in the INB group was 6.14 after injection and 3.86 after extraction, while in the ILI group, it was 5.46 and 2.90, respectively. There was a statistically significant difference between the two groups both after injection (p = 0.001) and extraction (p ConclusionThe intraligamentary injection technique (ILI) appears less painful during injection and provides profound pain relief during extraction. The results suggest that ILI can be used as a sole anaesthetic technique during extraction of lower anterior and premolar teeth.Trial registrationThis trial was retrospectively registered on 27/01/2023 with the identifier ISRCTN83272316 in Isrctn.com.

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Background and aimThere is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries.MethodsA double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications.ResultsDemographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications.ConclusionSequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

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BackgroundThis study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.Materials and methodsThe current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and P ResultsThe patients' pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.ConclusionThe success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

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Context: Effective local anesthesia is essential in pediatric dentistry, especially during procedures like pulpectomy. While lignocaine with adrenaline is widely used, mepivacaine without a vasoconstrictor offers potential benefits in pediatric patients. Aims: This study aimed to compare the hemodynamic responses and pain perception associated with 3% mepivacaine (plain) versus 2% lignocaine with 1:100,000 adrenaline in children undergoing pulpectomy. Settings and Design: A randomized, double-blind controlled trial was conducted at the Department of Pediatric and Preventive Dentistry of Dr. R. Ahmed Dental College and Hospital, Kolkata, India. Materials and Methods: Fifty children aged 6–13 years with symptomatic irreversible pulpitis were randomly assigned to receive either mepivacaine or lignocaine through buccal infiltration. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and intraoperative pain (Wong–Baker FACES Pain Rating Scale) were recorded at four time points (preoperatively, 5-, 15-, and 30-min postadministration). Statistical Analysis Used: Comparisons within the group over different time points were performed using Friedman’s test, while intergroup comparisons at each time point were assessed using the Mann–Whitney U-test. All analyses were conducted with the significance level set at 5%. Results: The mepivacaine group showed significantly lower HR at T1 (P < 0.0001) and reduced postoperative pain scores (P = 0.0046). SBP and DBP changes were less pronounced compared to lignocaine, though not statistically significant. Conclusions: Mepivacaine without vasoconstrictor provided effective anesthesia with better hemodynamic stability and pain control, supporting its use as a safe alternative in pediatric endodontics, especially where epinephrine use is undesirable.

Abstract licence: CC BY-NC-SA 4.0

ObjectiveLidocaine is the standard dental local anesthetic, while mepivacaine is gaining use despite higher cost and limited comparative data. This study compared the anesthetic efficacy (onset, duration, success rate) of 2% lidocaine with 1:100,000 epinephrine versus 2% mepivacaine with 1:100,000 epinephrine for inferior alveolar nerve block (IANB) in healthy young adults. A secondary aim was to assess whether lidocaine could serve as a cost-effective alternative without reduced clinical performance, particularly when administered by undergraduate dental students.MethodsA double-blind, randomized clinical trial was conducted involving 62 healthy dental students aged 19-21 years. Participants were randomly assigned to receive either 2% lidocaine or 2% mepivacaine with 1:100,000 epinephrine via conventional IANB technique. The onset time was assessed by pin-prick and cold testing, while the duration of anesthesia was determined by participant self-report. Anesthetic success was defined as achieving effective anesthesia within 10 min post-injection. Adverse events were recorded throughout the study. Group comparisons were analyzed using independent t-tests and chi-square tests, with statistical significance set at P ResultsThe mean onset time was 5.17 ± 1.96 min for lidocaine and 5.52 ± 1.57 min for mepivacaine (P = 0.435). The mean duration of anesthesia was 214.25 ± 47.52 min for lidocaine and 234.32 ± 39.02 min for mepivacaine (P = 0.073). The success rate within 10 min was 78.6% for lidocaine and 91.2% for mepivacaine, though the difference was not statistically significant. Gender-based subgroup analysis showed no significant differences in anesthetic response. Both anesthetics were well tolerated, with only one minor adverse event reported in the mepivacaine group.ConclusionFor inferior alveolar nerve blocks in healthy young adults, lidocaine and mepivacaine performed similarly in terms of onset, duration, and success rate when administered by undergraduate dental students. This suggests both agents provide predictable anesthesia. Given its lower cost and comparable performance, lidocaine may represent a cost-conscious option for routine dental anesthesia. More extensive research with diverse patient groups and operator experience levels is needed to confirm these findings and broaden their applicability.Clinical trial registrationRegistration number is "TCTR20250106002", and date of registration is 06/01/2025, https://www.thaiclinicaltrials.org/show/TCTR20250106002 .

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