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

We performed a systematic review and network meta-analysis (NMA) to assist clinicians in determining the optimal patient-specific method of analgesia during radial artery puncture by comparing radial artery puncture procedural pain. We included randomized controlled trials that assessed the prophylactic efficacy of local anesthesia for radial artery puncture-associated pain. We searched the Medical Literature Analysis and Retrieval System Online in January 2023, the Cochrane Central Register of Controlled Trials in January 2023, the Excerpta Medica Database in December 2022, the World Health Organization International Clinical Trials Platform Search Portal in January 2023, and ClinicalTrials.gov in January 2023. We synthesized the pain scores (0-100 scale) using the frequentist random-effects NMA model. We evaluated the confidence in each outcome using the CINeMA tool (https://cinema.ispm.unibe.ch/). We conducted an NMA of 1,619 patients across 14 studies on pain scores during radial artery puncture-related procedures for 12 interventions. Compared with placebo, mepivacaine infiltration and lidocaine spray probably reduce pain (mean difference (MD): -47.67, 95% confidence interval (CI): -61.45 to -33.89, confidence rating (CR): moderate; MD: -27.38, 95% CI: -37.53 to -17.22, CR: moderate). Of the 32 studies included, none reported systemic adverse events, such as anaphylaxis or local anesthetic systemic toxicity, or severe local adverse events. In conclusion, mepivacaine infiltration and lidocaine spray probably reduce the pain associated with radial artery puncture more than other local anesthesia.

Abstract licence: CC BY

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.

Abstract licence: CC BY

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.

Abstract licence: CC BY-NC-SA