Mepivacaine 66mg/2.2ml 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.

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BackgroundLocal anesthesia is a cornerstone of office-based oral and maxillofacial surgical practice, but achieving predictable anesthesia in mandibular procedures remains a persistent clinical challenge.PurposeThis umbrella review aimed to synthesize high-level evidence on the efficacy, safety, and clinical performance of 4% articaine in oral and maxillofacial anesthesia, with emphasis on nerve block and infiltration strategies.Study designAn umbrella review of systematic reviews and meta-analyses was conducted following Preferred Reporting Items for Overviews of Reviews guidelines.MethodsElectronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and Embase. The Population Intervention Comparison Outcomes framework included patients undergoing oral and maxillofacial surgical procedures; the intervention was 4% articaine; comparators were other local anesthetics; and outcomes included anesthetic success, latency, duration, need for supplemental anesthesia, and adverse events. Twenty-five systematic reviews were included, encompassing 228 primary studies. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), and overlap was quantified using the corrected covered area (3.18%).ResultsA total of 171 records were identified, of which 25 reviews (14.6%) were included. Articaine did not demonstrate consistent superiority over lidocaine or mepivacaine for inferior alveolar nerve block, particularly in inflammatory conditions. However, articaine significantly improved anesthetic success when used as supplemental buccal infiltration following block failure and as primary infiltration in posterior mandibular regions, reducing the need for reinjection. In surgical procedures, including third molar extraction, articaine demonstrated faster onset and comparable duration. Adverse event rates were similar across anesthetics, with no evidence of increased risk of persistent paresthesia.ConclusionsArticaine is not intrinsically superior for mandibular nerve blocks but provides clinically meaningful advantages when used in infiltration-based strategies. These findings indicate that anesthetic success is primarily determined by technique optimization rather than anesthetic selection alone.

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BackgroundFear of pain associated with intrauterine device (IUD) placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods.ObjectiveTo assess whether instillation of intrauterine mepivacaine before IUD placement alleviates pain more effectively than a placebo.Study designWe conducted a multicenter, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing IUD placement. An intrauterine instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to IUD placement. Pain scores were assessed using a 100 mm visual analog scale (VAS) at prespecified time points. Primary outcome measured the difference in VAS pain scores between the intervention group and the placebo group during IUD placement. Secondary outcomes included VAS pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method.ResultsWe enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% confidence interval (CI) 5.75-20.87; PConclusionThe intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during IUD placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.

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Introduction: Hysteroscopy is a key gynecological procedure for diagnosing and treating endometrial conditions. While hysteroscopy is often performed in office settings without sedation, patients frequently report significant pain during the procedure. This study aims to evaluate the efficacy of paracervical anesthesia with mepivacaine compared to placebo in managing pain during office hysteroscopy. Methods: This randomized, single-center, double-blind, placebo-controlled trial was conducted at Puerta de Hierro University Hospital (Madrid, Spain) from June 2021 to June 2022. A total of 108 women were randomized to receive either mepivacaine 2% or a saline placebo prior to hysteroscopy. Pain was assessed using a visual analog scale (VAS) at various stages of the procedure. Results: The results showed no significant differences in pain levels between the mepivacaine and placebo groups during the procedure. Both groups exhibited similar rates of complications and procedural difficulties. Factors influencing perceived pain included a history of vaginal delivery and the type of instruments used, but anesthesia did not demonstrate a significant impact on pain reduction in any subgroup. Discussion: Our findings indicate that paracervical anesthesia with mepivacaine does not significantly reduce pain during office hysteroscopy, consistent with previous studies. The variability in pain experiences suggests that individual factors, such as pain thresholds and anxiety, may play a significant role. A more personalized approach to pain management, combining pharmacological and non-pharmacological strategies, may be necessary to enhance patient comfort. Future research should involve larger multicenter trials to further explore these findings.

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BackgroundIntravenous dexamethasone and dexmedetomidine are two adjuncts to local anaesthetics used independently to prolong analgesia after peripheral nerve block. This randomised, controlled, triple-blind trial tested the hypothesis that the combination of i.v. dexamethasone and dexmedetomidine would provide superior analgesia than i.v. dexamethasone alone as an adjunct in patients undergoing upper limb surgery with a supraclavicular brachial plexus block.MethodsWe randomised 100 participants to receive either dexamethasone 0.15 mg kg-1 i.v. (Dexa group) or a combination of dexamethasone 0.15 mg kg-1 and dexmedetomidine 1 μg kg -1 i.v. (Dexa-Dexme group). The primary outcome was the duration of analgesia measured from the time of block procedure with a mix of mepivacaine 0.5% and ropivacaine 0.25% to first oral opioid intake. Secondary outcomes included duration of sensory and motor blocks, pain scores at rest and on movement, cumulative oral morphine consumption at 48 h, and incidence of hypotension episodes and bradycardia.ResultsThe mean (sd) duration of analgesia was 621 (334) min in the Dexa group and 690 (544) min in the Dexa-Dexme group (P=0.47). Similarly, there were no significant differences in the secondary outcomes.ConclusionsThe combination of i.v. dexamethasone and dexmedetomidine does not provide superior analgesia than i.v. dexamethasone alone after supraclavicular brachial plexus block.Clinical trial registrationNCT05389852.

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