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At least 163 records · Page 9Linked to original sources
PubMed2004

Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently.

UNLABELLED: Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.

Adult↗
PubMed2005

The effects of clonidine added to mepivacaine for paronychia surgery under axillary brachial plexus block.

We hypothesized that onset of sensory block is delayed in infected versus healthy tissues within the same nerve distribution after axillary brachial plexus block (ABPB) and that clonidine added to mepivacaine would enhance anesthesia and postoperative analgesia. Forty-one outpatients undergoing thumb/index paronychia surgery under ABPB were randomly assigned to receive in a double-blind fashion 400 mg mepivacaine plus either 100 microg clonidine (clonidine group, n = 21) or 2 mL saline (placebo group, n = 20). Onset of sensory block in the infected area was delayed compared with healthy areas of the same nerve distribution (24.7 +/- 5.5 min versus 21.3 +/- 7.2; P = 0.02 for median and 21.6 +/- 7.8 min; P = 0.04 for radial) within the placebo group. In the clonidine group, when compared to placebo i) onset of sensory block in both the median and radial nerve territories was accelerated (11.1 +/- 5.6 and 10.5 +/- 5.2 versus 21.3 +/- 7.2 and 21.6 +/- 7.8 min, respectively; P < 0.001), ii) onset of sensory block in the region of infection was accelerated (9.1 +/- 1.9 versus 24.7 +/- 5.5 min; P < 0.001), iii) duration of anesthesia (275 +/- 75 versus 163 +/- 57; P = 0.04) and time to first analgesic requirement (279 +/- 87 versus 197 +/- 84 min; P = 0.002) were prolonged with decreased visual analog scale scores at this time (30 +/- 18 versus 70 +/- 24; P < 0.001), and iv) verbal numeric rating scores were decreased at 24 h (1.7 +/- 2.2 versus 4.1 +/- 3.0; P = 0.002) and 48 h (0.1 +/- 0.5 versus 1.5 +/- 2.4; P = 0.01) postoperatively. Our findings suggest that in the setting of distal infected tissue surgery under ABPB infected tissues are resistant to anesthesia compared with healthy areas within the same nerve distribution and clonidine added to mepivacaine enhances both anesthesia and postoperative analgesia.

Adrenergic alpha-Agonists↗
PubMed2005

The incidence of transient neurologic symptoms after spinal anesthesia with mepivacaine.

We prospectively evaluated 1273 patients who received spinal (or combined spinal-epidural [CSE]) anesthesia with 1.5% mepivacaine (plain, no glucose) for ambulatory surgery. We hypothesized that analysis of a large series of patients would confirm previous findings that isobaric 1.5% mepivacaine is not frequently associated with transient neurologic symptoms (TNS). Patients were contacted twice after the anesthetic, at days 1-4 and days 6-9. One-thousand-two-hundred-ten patients were successfully contacted postoperatively (95% follow-up rate). None of the patients had permanent neurologic sequelae from the anesthetic. None of the 372 CSE anesthetics was inadequate for surgery. Fourteen of 838 (1.7%) of the spinal anesthetics were inadequate. TNS, defined as the new onset of back pain that radiated bilaterally to buttocks or distally, occurred in 78 patients (6.4%; 95% confidence intervals 5.1%-8%). The mean age of patients who developed TNS (48 +/- 14 yr) was older than that of patients without TNS (41 +/- 16 yr) (P < 0.001). TNS was not influenced by gender or intraoperative position. The frequent success rate and infrequent rates of complications such as TNS and postdural puncture headache suggest that spinal anesthesia with mepivacaine is likely to be a safe and effective anesthetic for ambulatory patients.

Adolescent↗
PubMed2006

The role of temperature in the action of mepivacaine.

The role of temperature in the action of local anesthetics was studied in 20 healthy young volunteers with plain 3% mepivacaine injected periapically twice in their maxillary first premolar, the first time with the solution at a temperature of 20 degrees C and the second time at 4 degrees C. The pulpal response was measured with a pulp tester every minute. The onset of pulp anesthesia was found to be of no statistical difference between 20 degrees C and 4 degrees C. On the other hand, mepivacaine at a temperature of 4 degrees C was found to have a statistically significant longer duration of action. Our conclusion is that the drop in temperature of mepivacaine from 20 degrees C to 4 degrees C provides a longer duration of pulpal anesthesia.

Adult↗
PubMed1999

[Urinary retention as a transient neurologic symptom after accidental total spinal anesthesia with mepivacaine hydrochloride].

We report a patient in whom urinary retention as a transient neurologic symptoms (TNS) developed after accidental total spinal anesthesia with mepivacaine hydrochloride. Mepivacaine, an amide local anesthetic, has been used for spinal anesthesia and considered one of the best for spinal anesthesia for its low incidence of TNS. However, we suggest that TNS associated with mepivacaine might not be a rare complication in spinal anesthesia.

Adult↗
PubMed2001

Mepivacaine: update on an evergreen local anaesthetic.

Many local anaesthetics are presently available for clinical use. The choice of a particular agent for a particular regional anaesthetic is based mainly on its clinical and pharmacological features. Besides these, safety of drugs and the knowledge of side effects associated with their use can play a major role, since serious complications can be related to local anaesthetics administration. Pharmacologic features of mepivacaine are: its amide structure (therefore it is not detoxified by circulating plasma esterases), its rapid metabolism, which take place into the liver, and its rapid excretion via the kidneys. Clinically, mepivacaine shows: short onset time, very close to lidocaine, intermediate duration and low toxicity. Mepivacaine can be therefore considered as a first choice agent for peripheral nerve blocks, particularly in high cardiac risk patients.

Anesthetics, Local↗
PubMed2004

[Anesthetic efficacy of 2% mepivacaine in conservative dentistry].

OBJECTIVE: To determine the efficacy of 2% mepivacaine in conservative dentistry. METHODS: The patients who needed cavity preparation or access to pulp chamber received local infiltration with 2% mepivacaine. Anesthesia time, anesthetic efficacy and cardiovascular system influences were assessed. 3% lidocaine with epinephrine served as control. RESULTS: In experiment group, the anesthesia effects were quicker and anesthesia duration was longer than that in control group. Doctors highly appreciated the anesthetic efficacy. Two groups did not show any evident change in blood pressure and heart rate. CONCLUSION: 2% mepivacaine is a safe and efficacious local anesthetic drug in conservative dentistry.

Adolescent↗
PubMedDate not supplied

Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.

BACKGROUND AND OBJECTIVES: This study evaluates the effects of clonidine added to mepivacaine on the duration of anesthesia and analgesia after axillary brachial plexus block. METHODS: Thirty patients scheduled for elective hand surgery were divided into three equal groups in a randomized, double-blinded fashion. An axillary perivascular brachial plexus block was performed with 40 ml 1% mepivacaine plus 1:200,000 epinephrine in the three groups. Group B also received 150 micrograms clonidine subcutaneously and Group C had the same dose of clonidine mixed with the local anesthetic and injected into the plexus sheath. The following variables were recorded: onset time, duration of anesthesia, duration of analgesia, postoperative pain score, intake of analgesics, and adverse effects. RESULTS: The three groups were comparable in terms of age, sex, weight, height, onset time of anesthesia, postoperative pain score, and analgesic requirement. The duration of anesthesia and analgesia was comparable in Groups A and B, but both variables were significantly increased in Group C: the duration of anesthesia and analgesia were prolonged, respectively, by 37 +/- 6% and 103 +/- 16% when compared to Group A and by 32 +/- 7% and 89 +/- 15% when compared to Group B. No side effects were reported. CONCLUSIONS: One hundred fifty micrograms clonidine added to mepivacaine for brachial plexus block prolongs the duration of anesthesia and analgesia. Our results suggest that this effect of clonidine is local rather than systemic.

Adult↗
PubMed2007

Evaluation of lidocaine and mepivacaine for inferior third molar surgery.

OBJECTIVE: The aim of this study was to compare 2% lidocaine and 2% mepivacaine with 1:100,000 epinephrine for postoperative pain control. STUDY DESIGN: A group of 35 patients, both genders were recruited, whose had ages ranged from 13 to 27 years-old and had two inferior third molars in similar positions to be extracted. The cartridges were distributed to the patients according to a randomised pattern, where lidocaine was in the control group and mepivacaine in the experimental group. RESULTS: Results showed no significant association between the anesthetics and postoperative pain, pulp sensibility after one hour, gender, tooth position and duration of the surgical procedure. CONCLUSIONS: It was shown that lidocaine and mepivacaine have similar time of anesthesia, they are adequate for surgical procedures that last one hour, and there was no difference between the two anesthetics in relation to the severety of post-operative pain.

Adolescent↗
PubMed1991

[The effect of continuous epidural infusion of a combination of 1% mepivacaine and buprenorphine for post-operative pain relief].

Using a portable 2 ml.hr-1 type infusor (Baxter Infusor), the effect of continuous epidural infusion for post-operative pain relief for 72 hours was studied in 32 patients after upper abdominal surgery. The patients were randomly allocated into four groups: Group 1 (n = 8) received continuous epidural infusion of 1% mepivacaine and buprenorphine 0.2 mg (48 ml.hr-1); group 2 (n = 8) 1% mepivacaine and buprenorphine 0.4 mg (48 ml.hr-1); Group 3 (n = 8) saline and buprenorphine 0.2 mg (48 ml.hr-1); Group 4 (n = 8) saline and buprenorphine 0.4 mg (48 ml.hr-1). The effect was evaluated at intervals of 12-hour until 72 hours postoperatively. Patients received supplemental buprenorphine intramuscularly as needed. In each period during the 12 to 72-hour after operation, the percentage of the patients who needed no supplemental buprenorphine was 62.5-100%, which is higher than during the 0 to 12-hour (25.0%). The percentage of the patients who showed no pain on coughing and changing in position in Group 1 and 2 was higher than in Group 3 and 4 in each period (P less than 0.05 12-24 and 36-72 hr). Continuous epidural infusion using Baxter Infusor with the combination of 1% mepivacaine and buprenorphine is effective for alleviating postoperative pain during the 12 to 72 hours after the operation, and for prevention of pulmonary complications.

Abdomen↗
PubMed1990

[An infusion model for intraoperative peridural anesthesia by catheter using mepivacaine].

With the introduction of repetitive or continuous catheter techniques in regional anaesthesia, potential systemic intoxication hazards have increased. Especially high dose techniques such as peridural anaesthesia or plexus brachialis blockade consecutively generate high blood levels. In this study, blood levels collected from 20 patients (36 +/- 19 y, 173 +/- 9 cm, 73 +/- 15 kg) after lumbar epidural anaesthesia with mepivacaine led to the development of a linear open one-compartment-model (VD,ss: 109 l, Cltot: 594 ml/min, t1/2abs: 13 min, t1/2 beta: 149 min). With that model, dosage strategies could be studied via computer simulation. A mepivacaine dosage regimen for lumbar epidural anaesthesia, consisting of 250 mg as an initial bolus dose and an infusion rate of 150 mg/h after 15 min, cumulated to maximum concentrations of 2.5-3.5 micrograms/ml after 150 min. Such an infusion regimen may lead to concentrations of more than 4 micrograms/ml if applied for longer than 4 h. The pharmacokinetic computer simulation proved to be precise and could be compared to the measured blood levels of mepivacaine.

Adult↗
PubMedDate not supplied

Behavioral effects of mid-pregnancy administration of lidocaine and mepivacaine in the rat.

Sperm-positive female Long-Evans hooded rats were injected with 6 mg/kg lidocaine (with epinephrine), 6 mg/kg mepivacaine, or saline, into the masseter muscle of the jaw on Day 11 of gestation. Birth, growth, and litter composition were unaffected by the drug treatment, as was shuttle box acquisition. Offspring of drug-treated dams had longer latencies than controls on the first day of negative geotaxis training, and were more sensitive to electric footshock. Lidocaine-dosed offspring responded less in the presence of the correct cue in the visual discrimination task, and mepivacaine-dosed animals were hypoactive in the open field. In a second study, offspring of lidocaine-dosed dams were slower to develop the righting reflex, made more errors in acquiring a water maze, had longer suppression times in a conditioned suppression task, and had longer latencies in the tail flick test. Dosing had no effect upon birth and growth, shuttle box, or footshock sensitivity. These data demonstrate that midgestational exposure to lidocaine or mepivacaine at a dose near the limits of permissible human exposure produces significant behavioral changes in the offspring. This preliminary study suggests that development of some portion of the central nervous system is altered by such exposure. Further work is required to determine the parameters and the extent of the effect.

Animals↗
PubMed1986

[Mepivacaine in brachial plexus anesthesia in surgical interventions of long duration].

To evaluate the use of mepivacaine-HCl for continuous axillary brachial plexus block for surgery lasting several hours a prospective study was performed. Mepivacaine-HCl 400 mg was injected every two hours. Over a period of eight to twenty hours there was in all cases adequate analgesia and muscle relaxation for microsurgical repair of limbs. Mean serum levels of mepivacaine-HCl did not exceed the concentration of 5-6 micrograms/ml. There were no side effects caused by the local anaesthetic agent.

Anesthesia, Conduction↗
PubMed1986

[Plexus anesthesia with a bupivacaine-mepivacaine mixture. Clinical results and blood level].

A mixture of 0.2% bupivacaine and 0.75% mepivacaine was employed for brachial plexus block in 20 patients scheduled for surgery of the forearm-hand-region. Volumes of 40-60 ml were given. The spread of motor and sensory block was monitored during 80 min. The first postoperative pain sensation was reported about seven hours after injection of the local anaesthetic. The results are compared to those obtained with 1% plain mepivacaine. The spread of the block was slightly slower after the mixture than after plain mepivacaine. Blood levels after the mixture showed a maximum 30 min after injection.

Brachial Plexus↗
PubMed1978

[Comparative studies of the local anaesthetic action of carticaine 1% and mepivacaine 1% (author's transl)].

The actions of carticaine 1% and mepivacaine 1% in peripheral nerve block were investigated in double-blind study. Bilateral ulnar nerve blocks were performed in 14 healthy subjects (age range 20-30 years), and latency, duration, and intensity of anaesthesia were quantitatively determined. There were no differences in latency of nerve block, but a significant difference in the duration of effect: Mepivacaine acted for nearly twice as long as Carticaine. In addition, several incomplete blocks were noted with Carticaine. On the basis of these results mepivacaine is preferred in peripheral nerve block because of its longer and more reliable action.

Adult↗
PubMed1982

Lidocaine and mepivacaine in cord blood.

The concentrations of lidocaine and mepivacaine were measured in stored cord blood samples from 200 deliveries. Newborn and obstetrical charts were reviewed for 100 deliveries for study of the association between cord blood concentrations, drug and route of recorded administration, Apgar scores at birth, and symptoms of possible toxicity. Detectable concentrations were commonly found (117/200), but toxic (3 micrograms/ml) levels were uncommon (4/200). However, recovery studies indicate these levels underestimate maximal exposure because both lidocaine and mepivacaine levels were shown to decrease in refrigerated stored blood. Although toxicity was seldom suspected, diagnostic accuracy was poor. The diagnosis was missed in the two patients with very high levels (5.0 and 9.0 micrograms/ml) of mepivacaine and levels measured in two suspected cases of toxicity were both low (0.4 microgram/ml). Associations between Apgar scores, cord levels, and route of administration (especially for lidocaine) were examined for 65 full-term uncomplicated deliveries. However, evaluation of these associations is problematic because dosages given, time or route of administration, and/or Apgar scores were often either not given or inconsistent with the clinical history. Detectable and potentially clinically significant local anesthetic drug concentrations were found in cord blood after all methods of administration, including local infiltration. These levels appear to underestimate the level of exposure because of instability of these anesthetics in stored cord blood samples. Local anesthetic toxicity appears to be difficult to detect clinically and may require cord blood level monitoring to detect.

Fetal Blood↗
PubMed1994

[Comparison of carbonated lidocaine and mepivacaine in epidural anesthesia].

OBJECTIVE: To compare carbonated mepivacaine to carbonated lidocaine in epidural anaesthesia. DESIGN: Nonrandomised control trial. SETTING: University Hospital. PATIENTS: Forty patients undergoing epidural anaesthesia for orthopaedic surgery. METHODS: Epidural anaesthesia at the fourth lumbar interspace, administering either carbonated mepivacaine 20 ml (group M, 20 patients) or carbonated lidocaine 20 ml (group L, 20 patients). Parameters recorded: onset of sensory block (time required to reach L1 and time required to reach the upper level), cranial spread of analgesia (number of dermatomes), duration of block (time between achievement of maximum spread of analgesia and regression of sensory block by two dermatomes) and motor block (Bromage score). RESULTS: No statistically significant differences have been found between group M and group L in the time required to reach L1 (means and standard deviations 6.3 +/- 3.8 and 6.5 +/- 2.1 minutes, respectively), in the time required to reach the upper level of analgesia (means and standard deviations 14.3 +/- 4.2 and 16.5 +/- 3.5 minutes, respectively), in the cranial spread of analgesia (means and standard deviations 7.1 +/- 3.4 and 7.6 +/- 2.7 dermatomes, respectively) and in the degree of motor block (means and standard deviations 1.5 +/- 0.8 and 1.1 +/- 0.8, respectively). Group M exhibited a much higher duration of sensory block, compared to group L (means and standard deviations 91.6 +/- 20.2 and 58.8 +/- 23.4 minutes, respectively, p < 0.001). CONCLUSIONS: Carbonated mepivacaine is more indicated than carbonated lidocaine in epidural anaesthesia when a high duration of sensory block is desired.

Adult↗
PubMed1993

[The effect of age on the spread of spinal anesthesia using isobaric 2% mepivacaine].

In the elderly, anaesthesia and surgery are associated with higher perioperative mortality and morbidity as compared to younger patients. There is some evidence that spinal anaesthesia may improve the postoperative state of elderly patients. A prospective study was performed to elucidate the effects of age on the characteristics of spinal anaesthesia with isobaric 2% mepivacaine. METHODS. Forty-six patients aged between 17 and 39 years and 48 elderly patients aged between 76 and 87 years having operations on the lower extremities or lower abdomen were investigated. All patients received 4.5 ml plain mepivacaine 2% (90 mg) as a subarachnoid injection in the L3-4 interspace in the sitting position. The patients were turned supine immediately after the injection. Time of onset, extent and duration of analgesia, motor block, and cardiovascular responses were assessed. The segmental level of sensory loss was tested using the pin-prick method. RESULTS. It was found that the time to maximal motor blockade was significantly decreased in the older age group compared to the younger group (7.9 vs 11.5 min). In the older group, the time to maximum spread was significantly shorter (11.4 vs 13.6 min). A significantly higher sensory block was obtained in the older group (T8 vs T10). The mean duration of analgesia or motor blockade did not differ significantly (200.7 vs 192.8 min). There were no unacceptably high degrees of spinal blockade. In the older group there was a tendency to a greater decrease in systolic arterial pressure as compared to preanaesthetic values (23.7% vs 16.3%) and greater falls in diastolic blood pressure were observed in the older group (22.1% vs 14.4%). A greater volume of lactated Ringer's solution was necessary in the older group (14.8 vs 10.3 ml/kg). Postspinal headache was encountered in 3 patients in the younger group and 2 in the older group. DISCUSSION. It is concluded that there was a tendency for greater spread of spinal analgesia with isobaric 2% mepivacaine in the elderly. The clinical significance of this finding is limited. In elderly patients hypotension is more common than in younger patients, but might not be related solely to age or extent of the neural blockade.

Adolescent↗