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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Background: Mepivacaine hydrochloride is commonly used for digital anaesthesia in United Kingdom podiatric practice, although representative prevalence data are lacking. Published maximum recommended doses vary, and the evidential base of exact mg/kg limits is often unclear. Dose limits remain important safeguards, but they are not individual toxicity thresholds. Methods: This structured narrative review updates a 2021 preprint. The original review searched MEDLINE, Embase, CINAHL and AMED. For this revision, the authors reassessed the earlier evidence base and updated searches of PubMed, reference lists, regulatory sources, product information, and professional guidance through to September 2026. Priority was given to current United Kingdom legislation and product information, systematic reviews, practice advisories and primary pharmacokinetic or clinical studies. This was not a systematic review; formal risk-of-bias appraisal and meta-analysis were therefore not undertaken. Results: Mepivacaine is an intermediate-acting amino-amide local anaesthetic with relatively limited vasodilator activity. Recommended adult doses differ between product information, formularies and textbooks. Treat these limits as conservative population-level safeguards rather than precise toxicity thresholds. Systemic exposure is influenced by total dose, concentration, injection site and speed, accidental intravascular administration, concurrent local anaesthetics and patient factors. Historical paediatric rules based on fractions of an adult dose are unsuitable for contemporary clinical dosing. Safe practice requires the lowest effective dose, incremental injection, dose calculation across all local anaesthetics, readiness to recognise local anaesthetic systemic toxicity and immediate access to an emergency plan. Conclusion: 3% mepivacaine remains a practical option for digital anaesthesia, but neither customary podiatric practice nor a single mg/kg figure is sufficient evidence of safety. Clinicians should follow current product information and legislation, individualise dosing conservatively and maintain competence and preparedness for local anaesthetic systemic toxicity.

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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.

Abstract licence: CC BY