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Specific Local Anesthetics

Specific Local Anesthetics. Amides. Lidocaine Mepivacaine Prilocaine Bupivacine Etidocaine. Other Amides. Articaine - supposedly greater diffusion - contraindications include anemia, methemoglobinemia, sulfur allergy - not available in USA

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Specific Local Anesthetics

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  1. Specific Local Anesthetics

  2. Amides Lidocaine Mepivacaine Prilocaine Bupivacine Etidocaine

  3. Other Amides Articaine - supposedly greater diffusion - contraindications include anemia, methemoglobinemia, sulfur allergy - not available in USA Dibucaine - serum cholinesterase survey for atypical enzymes normal value : dibucaine number = 66 - 86 abnormal values decreased as low as 20

  4. Esters Procaine Cocaine Benzocaine Tetracaine

  5. Lidocaine Concentration - 2% Potency - 2X Procaine Toxicity - 2X Procaine Metabolized - Liver Excreted - Kidney

  6. Lidocaine % Vasoconstrictor Duration 2 without pulp - 5-10 mins tissue - 1-2 hrs 2 1:50,000 epi pulp - 60 mins tissue - 3-5 hrs 2 1:100,000 epi pulp - 60 mins tissue - 3-5 hrs

  7. Lidocaine Time to onset 2-3 mins Half life 90 mins Max rec dose (Malamed) 4.4 mg/kg (2 mg/lb) (manufac.) w/o epi 4.4 mg/kg (2 mg/lb) with epi 6.6 mg/kg (3 mg/lb)

  8. Lidocaine Maximum safe dose - 2% with 1:100,000epi Malamed - 300 mg or 8 carpules manufac. - 500 mg or 13.5 carpules

  9. Mepivacaine Concentration - 2% or 3% Potency - 2X Procaine Toxicity - 1.5-2X Procaine Metabolized - Liver Excreted - Kidney

  10. Mepivacaine % Vasoconstrictor Duration * 3 without pulp - 20-40 mins tissue - 2-3 hrs 2 1:20,000 pulp - 60-90 mins Levonordefrin tissue - 3-5 hrs 2 1:100,000 epi pulp - 45-60 mins 1:200,000 epi tissue - 2-5 hrs * weak vasodilator

  11. Mepivacine Time to onset 1.5-2 mins Half life 1.9 hrs Max rec dose (Malamed) 4.4 mg/kg (2 mg/lb) (manufac.) 6.6 mg/kg (3 mg/lb)

  12. Mepivacaine Maximum safe dose - 3% w/o vasoconstrictor Malamed - 300 mg or 5.5 carpules manufac. - 400 mg or 8 carpules

  13. Mepivacaine Maximum safe dose - 2% with constrictor Malamed - 300 mg or 8 carpules manufac. - 400 mg or 11 carpules

  14. Prilocaine Concentration - 4% Potency - 2X Procaine Toxicity - 1X Procaine Metabolized - Liver and Lungs orthotoluidine produced Excreted - Kidney

  15. Prilocaine % Vasoconstrictor Duration 4 without pulp - 10 mins infiltra. 60 mins block tissue - 1.5-4 hrs 4 1:200,000 epi pulp - 60-90 mins tissue - 3-8 hrs

  16. Prilocaine Time to onset 2-4 mins Half life 1.6 hrs Max rec dose all forms 6 mg/kg (2.7 mg/lb) Max safe dose all forms 400 mg or 5.5 carpules

  17. Bupivacaine Concentration - 0.5% Potency - 8X Procaine (4X Lidocaine) Toxicity - 8X Procaine (4X Lidocaine) Metabolized - Liver Excreted - Kidney

  18. Bupivacaine % Vasoconstrictor Duration 0.5 1:200,000 epi pulp - 90-180 mins tissue - 4-9 hrs, up to 12 hrs reported

  19. Bupivacaine Time to onset 6-10 mins Half life 2.7 hrs Max rec dose 1.3 mg/kg (0.6 mg/lb) Max safe dose 90 mg or 10 carpules

  20. Etidocaine Concentration - 1.5% Potency - 8X Procaine (4X Lidocaine) Toxicity - 4-8X Procaine (2-4X Lidocaine) Metabolized - Liver Excreted - Kidney

  21. Etidocaine % Vasoconstrictor Duration 1.5 1:200,000 epi pulp - 90-180 mins tissue - 4-9 hrs

  22. Etidocaine Time to onset 1.5-3 mins Half life 2.6 hrs Max rec dose 8 mg/kg (3.6 mg/lb) Max safe dose 400 mg or 15 carpules

  23. Procaine Concentration - 2-4% Potency - 1 Toxicity - 1 Metabolized - hydrolyzed in plasma by pseudocholinesterase to PABA Excreted - Kidney No longer available in dental carpules

  24. Procaine Time to onset 6-10 mins Half life 0.1 hr Duration pulp - 30-60 mins (with v/c) tissue - 2-3 hrs Max rec dose 6.6 mg/kg (3 mg/lb) Max safe dose 400 mg

  25. Procaine Strong vasodilation - very short duration of pulpal anesthesia High incidence of allergic reactions Drug of choice for Tx of inadvertant intra-arterial injection (relieves pain and spasm) Consider for Amide allergic patient

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