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

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