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PubMed1983

Lung uptake of lidocaine in man as influenced by anaesthesia, mepivacaine infusion or lung insufficiency.

Pulmonary uptake of lidocaine was investigated in patients before surgery, and aimed at elucidating the influence of general anaesthesia, the presence of another local anaesthetic agent in the blood, or the possible impact of lung insufficiency. When the lung uptake of lidocaine, injected as a bolus together with indocyanine green dye, was calculated as uptake at 95% pass of the dye, there were no statistically significant differences between the four groups. When the extraction in each of the arterial blood samples was calculated on the basis of the relation between relative concentrations, there were statistically significant differences, with a general tendency towards higher extraction of lidocaine in the awake, healthy volunteers, not given mepivacaine, compared to the other groups. In the group in whom mepivacaine was infused, the arterial concentration of mepivacaine increased transiently after the injection of lidocaine. This probably reflects a displacement of mepivacaine from binding sites for both agents. From this study, it is postulated that the ability of the pulmonary circulation to clear the blood of lidocaine is high, and that it is not affected markedly by those situations studied in the present investigation.

Adult↗
PubMed1993

A double-blind comparison of lidocaine and mepivacaine during epidural anaesthesia.

The effects of epidural anaesthesia with plain 2% lidocaine or mepivacaine were compared in 200 patients undergoing extracorporeal shock wave lithotripsy in a double-blind manner. The onset, spread, duration and quality of analgesia were similar in both groups. The numbers of patients who needed vasoconstrictor or atropine were almost equal in both the lidocaine and the mepivacaine groups. Mild but significant hypotension continued for a longer period in the mepivacaine group than in the lidocaine group. A transient decrease in arterial oxygen saturation was seen in two patients receiving lidocaine and in three patients receiving mepivacaine. Mild systemic toxicity was observed in eight patients in both groups, although serious complications such as convulsions did not occur. It is concluded that both drugs can be used equally safely for epidural anaesthesia, although the maximum recommended doses differ.

Adolescent↗
PubMed1992

Alkalinization of mepivacaine for axillary block.

We examined the onset and distribution of sensory blockade, the onset of motor blockade, and venous mepivacaine concentrations after axillary block with 1.25% mepivacaine with and without bicarbonate. There were no statistically significant differences between the alkalinized and placebo groups with respect to distribution of analgesia or anesthesia, time to onset of analgesia, or time to onset of paresis. However, alkalinization significantly decreased the time to onset of anesthesia in the medial cutaneous nerve of the forearm, the median nerve, and the ulnar nerve, as well as the time to onset of paralysis. Concentrations of mepivacaine in venous blood did not differ significantly. We conclude that alkalinized mepivacaine offers the advantage of quicker onset of more profound blockade in several terminal nerve distributions.

Adult↗
PubMed1988

Pudendal block in vaginal deliveries. Mepivacaine with and without epinephrine.

Pudendal block with 20 ml 1% mepivacaine with and without epinephrine was performed in 151 patients during the second stage of labor. No differences in efficacy of the block or in Apgar scores between the two groups were found. The maternal mepivacaine concentration was higher in the plain group than in the epinephrine group (p less than 0.01), but toxic levels were never reached. In the infants, no difference in mepivacaine concentration was found between the groups (p greater than 0.05, type II error 9%) and toxic levels were not reached. The time elapsed from the pudendal block until delivery was prolonged when epinephrine was added (p less than 0.02). We found no effect on blood pressure in either of the groups, with or without oxytocin and/or methergin. Twenty ml 1% mepivacaine (plain) is a safe choice for pudendal block without the possible disadvantages of adding epinephrine.

Anesthesia, Obstetrical↗
PubMedDate not supplied

[Addition of fentanyl to mepivacaine in axillary brachial plexus block. Effects on the anesthetic and postoperative analgesic quality].

The possible potentiating effect of phentanyl on mepivacaine in brachial plexus blockade was evaluated, both for operative anesthesia and postoperative analgesia. Sixty ASA I patients, scheduled for upper limb surgery, were selected and distributed in 3 groups: 1) Mepivacaine 1% 40 ml (control group); 2) Mepivacaine 1% 40 ml + phentanyl 100 micrograms; 3) Mepivacaine 1% 40 ml + subcutaneous phentanyl 100 micrograms. The latency time and the quality of anesthesia were evaluated. The duration of analgesia was evaluated on the basis of the time from the administration of the first analgesic. There were no significant differences between the 3 groups in the latency times of the development of blockade nor in the quality of surgical anesthesia. Also, there were no significant differences in the duration of postoperative analgesia (307, 316 and 326 minutes, respectively, in each group). It was concluded that the addition of phentanyl 100 micrograms to the local anesthetic in the axillary blockade of the brachial plexus does not change the anesthetic characteristics nor the time of postoperative analgesia.

Adult↗
PubMedDate not supplied

Alkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery.

Reports evaluating the effect of alkalinization of mepivacaine on the onset of regional anesthesia have been controversial. The effect of alkalinization of mepivacaine on the onset of interscalene block has not been reported and is the subject of this study. Forty patients received an interscalene block by elicitation of paresthesia with 25-gauge, blunt level needle. Twenty patients received 40 ml 1.4% mepivacaine, which contained epinephrine (1:200,000). Another 20 patients received 40 ml 1.4% mepivacaine, epinephrine (1:200,000), and 4 mEq of NaHCO3. Time to onset of block was determined by awareness of cold, and loss of pain perception and motor function at the shoulder, elbow and hand. The duration of block for each observation was determined. The onset was significantly faster for all tested modalities in the pH-adjusted group. No statistically significant differences in the duration of either motor or sensory were found between the study and control groups.

Bicarbonates↗
PubMedDate not supplied

Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block.

A combination of psoas compartment block and sciatic nerve block was performed with a total dose of 731.5 mg mepivacaine (55 ml, 1.33%) with epinephrine (1:600,000) in patients scheduled for orthopedic surgery on one leg. In 20 patients, arterial blood samples were collected at timed intervals over a 6-hour period to determine the mepivacaine plasma concentration. In all patients, good sensory and motor blocks were obtained and no analgesics were required during surgery. Despite the high dose of mepivacaine, the plasma concentrations stayed below 6.0 micrograms/ml, with one exception, although no clinical signs of local anesthetic toxicity were observed. Plasma pharmacokinetic variables of mepivacaine were as follows: Cmax: 4.22 mg.l-1 (SD, 1.28); Tmax: 0.99 hours (SD, 0.76); T1/2: 3.25 hours (SD, 1.12); CL 0.55 1.hour-1.kg-1.

Adult↗
PubMedDate not supplied

The effect of pH adjustment of 2% mepivacaine on epidural anesthesia.

Two-hundred men, scheduled for elective meniscectomy under epidural anesthesia, were randomly assigned to receive either a standard 2% mepivacaine solution (n = 100) or a pH adjusted 2% mepivacaine solution (pHAS, n = 100). The pHAS was freshly prepared before the block by adding 0.1 mEq of NaHCO3 per ml of mepivacaine solution. After a test-dose, the anesthetic solution was injected to produce a level of sensory anesthesia to T10. The mean duration of anesthesia and the mean dose of mepivacaine used were comparable between the groups. Patients in the pHAS group showed a significant shortening of onset time in T10 and in S2 segment (p less than .001). Grade 3 motor blockade was achieved in the same number of patients, but a faster motor block was observed in the pHAS group (p less than .05). Regression of both sensory and motor blockade in the two groups was not significantly different.

Adult↗
PubMed1989

Motor and sensory blockade after epidural injection of mepivacaine, bupivacaine, and etidocaine--a double-blind study.

In a double-blind study of epidural anesthesia, 30 young volunteers were given either 2% mepivacaine (400 mg), 0.5% bupivacaine (100 mg), or 1.5% etidocaine (300 mg), all solutions containing epinephrine (1:200,000). The spread of analgesia was equal in the groups, whereas the longest duration was noted in the etidocaine and bupivacaine groups. With use of a method for determining muscle force, motor blockade during anesthesia was recorded quantitatively for hip flexion, knee extension, and plantar flexion of the big toe. Onset of motor blockade was significantly more rapid with etidocaine than with bupivacaine and mepivacaine. All subjects given etidocaine developed complete motor blockade, but with the other local anesthetics 5%-33% of the initial muscle force remained. The least motor blockade was found in the L5-S2 segment (plantar flexion of the big toe). The duration of maximal motor blockade varied between 60 min (mepivacaine) and 360 min (etidocaine). With each of the three local anesthetics, motor function returned simultaneously in the three muscle groups tested. Complete restoration of muscle function occurred significantly later for etidocaine (600 min) than for bupivacaine (360 min) and mepivacaine (180 min). With etidocaine, the motor blockade outlasted the sensory blockade by 150 min. The Bromage scale corresponded to the motor blockade only during the first half of the regression phase. Not until 1-3 h after attainment of Bromage grade 0 was the muscle force of all movements restored (90% of control values).

Acetanilides↗
PubMed1987

[Bupivacaine and mepivacaine on artificial lipid membranes. A comparison of physicochemical parameters].

Mepivacaine and bupivacaine, frequently used local anesthetics, differ in a variety of clinical effects but show only small differences in chemical structure. In order to learn more about molecular mechanisms of action, we investigated the effects of these two local anesthetics on artificial membranes and liposomes. Methods. Artificial membranes were formed from dipalmitoylphosphatidylcholine - cholesterol or from a phospholipid mixture extracted from rabbit heart to separate into two aqueous phases (100 mM NaCl, 1 mM glycine, pH 7.4). Membrane current and potential were recorded after addition of local anesthetics on one side of the membrane. Electrophoretic mobility of liposomes, formed from phosphatidylcholine and a mixture of phosphatidylcholine with phosphatidylinositol, was measured by laser Doppler techniques. The surface potential (zeta potential) was calculated by Gouy-Chapman theory. Lipid/buffer partition coefficients were determined in phosphatidylcholine liposomes by centrifugation and spectrophotometric measurement of the concentration. Results. Mepivacaine and bupivacaine induce concentration-dependent electrostatic potentials on artificial membranes, resulting from incorporation of the charged drug form. Bupivacaine is more active than mepivacaine. The time of onset is short for mepivacaine and delayed for bupivacaine. The effects are retarded in the presence of glucose and are higher and more rapid for the carbonized form of bupivacaine (CO2 form instead of hydrochloride form). The electrostatic surface potential, measured by electrophoretic liposome mobility, is changed by the local anesthetics.(ABSTRACT TRUNCATED AT 250 WORDS)

Bupivacaine↗
PubMed1984

Plasma mepivacaine concentrations after caudal epidural and subarachnoid injection in the horse: comparative study.

The venous plasma concentrations of mepivacaine were determined in 7 adult mares (420 +/- 17.1 kg) given an injection of a 2% solution of the hydrochloride at either the sacral (S2-3 to S5-C1) epidural space or the midsacral (S2-3) subarachnoid space. An average dose of 91.4 +/- 15.7 mg (4.6 +/- 0.8 ml) was needed to produce caudal epidural analgesia (CEA) and 26.7 +/- 5.4 mg (1.3 +/- 0.3 ml) to produce caudal subarachnoid analgesia (CSA). Maximal caudal analgesia extended from spinal cord segments S-1 to coccyx during CEA and CSA. The onset of analgesia as measured by response to superficial and deep muscular pinprick stimulations was significantly (P less than 0.05) faster in mares with CSA than with CEA (8.3 +/- 2.4 minutes vs 21.4 +/- 3.8 minutes). The period of analgesia was significantly (P less than 0.05) longer in mares with CEA than with CSA (80.0 +/- 11.5 minutes vs 67.4 +/- 26.3 minutes). The rate of vascular absorption of mepivacaine from the epidural space was significantly (P less than 0.05) faster than from the subarachnoid space. Maximum venous plasma concentrations of mepivacaine were similar (P greater than 0.05) after epidural and subarachnoid injections (0.05 +/- 0.03 micrograms/ml and 0.05 +/- 0.03 micrograms/ml) at the same times after mepivacaine administration (51.4 +/- 33.4 minutes and 53.6 +/- 24.3 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Caudal↗
PubMed1980

Myotoxicity of single and repeated injections of mepivacaine (Carbocaine) in the rat.

Young rats received single or repeated injections of 2% mepivacaine (Carbocaine) into the tibialis anterior or extensor digitorum longus muscles. Repeated injections consisted of six injections of the anesthetic (100 microliter per injection into the tibialis anterior) on three different schedules, at intervals of 2 1/2 hours, 24 hours, or 4 days. The muscles that had been given injections were examined histologically for evidence of myotoxicity at 0 to 7 and 20 days after the last injection. Single injection studies showed that mepivacaine is a myotoxic drug, producing a lesion which ultimately results in the degeneration and subsequent regeneration of large amounts of muscle. A similar picture was seen with repeated injections except that greater tissue destruction was noted. Long-term studies following a single injection of mepivacaine showed restoration of the original muscle structure whereas after repeated injections some muscles showed persisting foci of increased intersitial connective tissue. This study shows that in rats 2% mepivacaine is a myotoxic drug, but that the damage it produces is to a large extent restored by the regeneration of new muscle fibers.

Animals↗
PubMed1980

[Carticaine and mepivacaine. a double blindstudy on longterm and diffusion action during blockade of the brachial plexus (author's transl)].

In a double blind study, using supraclavicular plexus blockade as a model, the latency and diffusion of carticaine in comparison with mepivacain was investigated. Up to 16 min after first eliciting paraesthesiae and injection somewhat more plexus blocks were complete with carticain than with mepivacaine. This difference was statistically valid only for motor block and not for sensory block. However, the relative proportion of complete motor and sensory block increased with mepivacain after 16 min and surpassed the results for carticaine. This difference is statistically significant for sensory block and for sensory and motor block combined. It is also valid for the results up to 30 min. The failure rate was significantly higher for carticaine than for mepivacaine. From these results the course and the failures are attributed to a poorer diffusion of carticaine.

Adolescent↗
PubMedDate not supplied

Alkalinization of mepivacaine improves the quality of motor block associated with interscalene brachial plexus anesthesia for shoulder surgery.

BACKGROUND AND OBJECTIVES: Interscalene block has produced appropriate anesthesia for shoulder surgery. Success is partly determined by the quality of motor block achieved. This study was designed to evaluate the influence of alkalinization of mepivacaine on the quality of motor block achieved with interscalene brachial plexus anesthesia. METHODS: The study design included a prospective, randomized trial of 2 groups of 20 patients each undergoing shoulder surgery by one surgeon with interscalene block. Both groups received interscalene block with 40 mL 1.4% mepivacaine, 1/200,000 epinephrine, using a 25-gauge, blunt-bevel needle and elicitation of paresthesia in the arm. One group had 1 mL sodium bicarbonate (1 mEq/mL) per 10 mL mepivacaine added and the other had an equal volume of saline. Average pH was determined for each solution in a nonclinical setting. Motor block was graded by a blinded observer after a standard 3-minute injection at 1 and 10 minutes after injection on a 0-5 standard neurologic scale. The surgeon, blinded to group selection, graded the quality of motor block as excellent, good, fair, or poor at preparation, incision, and 15 minutes postincision. RESULTS: Both groups were similar demographically. All blocks provided successful surgical anesthesia. Motor block quality was evaluated as better at all times in the study group (alkalinization) by both the blinded observer and the surgeon. CONCLUSIONS: Alkalinization of mepivacaine improves the quality of motor block after interscalene brachial plexus block for shoulder surgery.

Brachial Plexus↗
PubMedDate not supplied

Failed axillary brachial plexus block techniques result in high plasma concentrations of mepivacaine.

BACKGROUND AND OBJECTIVES: Unintentional extrasheath injection causes failed axillary brachial plexus block. We wanted to find out if extrasheath injections produce higher plasma concentrations of local anesthetics compared to intrasheath injections. We also studied the incidence of extrasheath injection with radiographs. METHODS: Axillary brachial plexus blocks were established using a catheter technique. Fifty milliliters of 1.5% mepivacaine without epinephrine mixed with contrast medium was injected through the catheter. An anteroposterior radiograph was used to determine the distribution of contrast medium. Mepivacaine concentrations in arterial plasma were compared when local anesthetic solution was injected unintentionally outside of the axillary neurovascular sheath (n = 6) and when it was injected correctly into the sheath (n = 6). The incidence of extrasheath injection was studied in a different series of 109 patients. RESULTS: Arterial plasma mepivacaine concentrations were higher after extrasheath injection [8.0 (6.3-9.7) vs 5.8 (4.5-7.0), microg/mL, means (95% confidence intervals), P < .05]. Pharmacokinetic parameters such as mean residence time and total clearance did not differ between intra- and extrasheath injections. Extrasheath injection was observed in 3.7% (4/109) of cases. CONCLUSION: Failed extrasheath injection of 50 mL 1.5% plain mepivacaine produces higher arterial plasma concentration in axillary brachial plexus block.

Adult↗
PubMed1993

pH adjustment of mepivacaine decreases the incidence of tourniquet pain during axillary brachial plexus anaesthesia.

The effect of pH adjustment of mepivacaine on the incidence of tourniquet pain during axillary brachial plexus anaesthesia was studied. Thirty-nine patients scheduled for hand surgery, during which use of pneumatic tourniquet for longer than 60 min was planned, were randomized into two groups. Both received axillary brachial plexus block with 40 ml, 1.4% mepivacaine, 1:200,000 epinephrine. The study group had 4 ml sodium bicarbonate (1 mEq.ml-1) added (final pH 7.31), and the control group had 4 ml saline added (final pH 5.6). The incidence of tourniquet pain was determined from cases for which tourniquet inflation lasted longer than 60 min. Tourniquet; pain was defined as poorly localized and distinct from an inadequate axillary block by a blinded observer. More tourniquet pain occurred in the control group. The authors conclude that alkalinization of mepivacaine for axillary brachial plexus anaesthesia may be indicated in cases where use of pneumatic tourniquet for long periods is planned.

Adult↗
PubMed1975

Clinical evaluation of the (+) isomer of mepivacaine.

A human clinical study was undertaken to evaluate the effectiveness and safety of dexivacaine 2 per cent, mepivacaine 2 per cent, and mepivacaine 3 per cent. A double-blind technique was used to evaluate time of onset, duration, depth of anesthesia, and side effects. Results indicated no significant differences among the three anesthetics, except that mepivacaine 3 per cent had a significantly longer duration of soft-tissue symptoms in the mandibular block series. The few side effects noted were minimal and of no statistical significance. The evaluation of an anesthetic by the several parameters employed and especially by the over-all opinion of the anesthesia was deemed a valuable research method whem comparing the clinical effectiveness of local anesthetics.

Adult↗
PubMedDate not supplied

Alkalinization of mepivacaine does not alter onset of caudal anesthesia.

STUDY OBJECTIVE: To determine the effect of alkalinization of mepivacaine on onset of caudal anesthesia. DESIGN: Randomized, blind study. SETTING: Colon-Rectal Surgery Service of the Tertiary Center at Cleveland Clinic Foundation. PATIENTS: Young, healthy adults undergoing anal surgery. INTERVENTIONS: Addition of bicarbonate (study group) or saline (control group) to mepivacaine. MEASUREMENTS AND MAIN RESULTS: At the onset of sacral anesthesia, demographics were measured. A slightly faster onset was found in the study group (4.28 vs. 6.08 minutes), but this was not statistically significant. CONCLUSIONS: Alkalinization of mepivacaine does not significantly accelerate the onset of caudal anesthesia.

Adult↗