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Mepivacaine

About: Mepivacaine is a research topic. Over the lifetime, 1350 publications have been published within this topic receiving 27893 citations. The topic is also known as: 1-methyl-2',6'-pipecoloxylidide & N-(2,6-dimethylphenyl)-1-methyl-2-piperidinecarboxamide.


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Journal ArticleDOI
TL;DR: Diaphragmatic paresis appears to be an inevitable consequence of interscalene brachial plexus block when providing anesthesia sufficient for shoulder surgery, as it is a practical, sensitive, and low-risk method for diagnosing hemidiaphragm function without radiation exposure.
Abstract: Interscalene brachial plexus anesthesia for shoulder surgery routinely includes sensory anesthesia of the fourth and fifth cervical nerves. The authors reasoned that some degree of diaphragm paralysis should result from interscalene blocks that produce surgical C3-C5 sensory anesthesia. In this investigation, ultrasonography was used to study the incidence of ipsilateral hemidiaphragmatic paresis during routine interscalene block, as it is a practical, sensitive, and low-risk method for diagnosing hemidiaphragmatic function without radiation exposure. Thirteen healthy patients received interscalene blocks using a paresthesia technique with 34-52 mL 1.5% mepivacaine with added epinephrine and bicarbonate. All developed cervical sensory anesthesia. Data were collected before and 2, 5, and 10 min after injection, and, when possible (11 of 13 patients), at hourly intervals after surgery. Changes from normal to paradoxical motion of the ipsilateral hemidiaphragm were seen in all 13 patients during sniff and Mueller maneuvers within 5 min (in 11 of 13 patients at 2 min). Diaphragmatic motion returned to normal in 10 of 11 patients between 3 and 4 h after injection and in the remaining patient by the fifth hour after injection. Diaphragmatic paresis appears to be an inevitable consequence of interscalene brachial plexus block when providing anesthesia sufficient for shoulder surgery.

502 citations

Journal ArticleDOI
TL;DR: The most important clinical properties of local anaesthetic agents are potency, onset, duration of action and relative blockade of sensory and motor fibres.
Abstract: The most important clinical properties of local anaesthetic agents are potency, onset, duration of action and relative blockade of sensory and motor fibres. These qualities are related primarily to the physicochemical properties of the various compounds. In general, lipid solubility determines the relative intrinsic potency of the various agents, while protein binding influences the duration of anaesthesia and pKa is correlated with the onset of action. In general, the local anaesthetics for infiltration, peripheral nerve blockade, and extradural anaesthesia can be classified into three groups: agents of low potency and short duration, for example procaine and chloroprocaine; agents of moderate potency and duration, for example lignocaine, mepivacaine and prilocaine; and agents of high potency and long duration, for example amethocaine, bupivacaine and etidocaine. These local anaesthetics also vary in terms of onset: chloroprocaine, lignocaine, mepivacaine, prilocaine and etidocaine have a rapid onset, while procaine, amethocaine and bupivacaine are characterized by a longer latency period.

299 citations

Journal ArticleDOI
TL;DR: The effects of pH buffering on the pain of administration and efficacy of three local anesthetics and the area of anesthetized skin surrounding each injection site was measured and buffering the local anesthetic significantly reduced the mean quantitative pain estimates.

284 citations

Journal ArticleDOI
TL;DR: Blood concentrations of local anaesthetics after perineural injection are not closely related to age, weight or pregnancy but may be influenced by diseases associated with haemodynamic changes and by other drugs given at or around the time of regional blockade.
Abstract: The introduction of the new long acting local anaesthetics, bupivacaine and etidocaine, has stimulated an expansion of interest in regional anaesthesia, particularly for obstetrical applications and pain therapy. Systemic toxicity following injection of local anaesthetics occurs albeit infrequently, and tentative correlations have been made between the onset of CNS and cardiovascular effects and circulating drug concentrations in both adults and neonates. Amongst other factors, interpretation of these relationships depends upon blood distribution and plasma binding of the agents, sampling sites and acid-base balance. The disposition kinetics and placental transfer of the amide type agents have been well characterised. In adults their clearance is almost entirely hepatic but in neonates an increase in the renal component is, in part, a reflection of the immaturity of some of the enzymes responsible for their metabolism. Ester type agents are rapidly hydrolysed by plasma pseudocholin-esterase and this has led to a preference for chloroprocaine in some obstetric procedures. Major determinants of the systemic absorption of the agents after perineural administration include their physicochemical and vasoactive properties, perfusion and tissue binding at the site of injection and whether or not adrenaline has been added. In respect of blood drug concentrations achieved after various regional anaesthetic procedures, the margin of systemic safety appears to favour bupivacaine and etidocaine compared to shorter acting analogues such as lignocaine and mepivacaine. The time course of local anaesthetic remaining at the site of injection has been calculated following intravenous regional anaesthesia and peridural block. This has allowed prediction of the local and systemic accumulation of the drugs following continued dosage. Blood concentrations of local anaesthetics after perineural injection are not closely related to age, weight or pregnancy but may be influenced by diseases associated with haemodynamic changes and by other drugs given at or around the time of regional blockade.

280 citations

Journal ArticleDOI
TL;DR: Differences in absorption rates between the bupivacaine isomers similar to those demonstrated for the mepivacsine isomers indicate differences in infiltration anaesthesia by L(-)–bupavacaine.
Abstract: Mepivacaine: There was no difference in toxicity between the two optical isomers of mepivacaine after rapid intravenous injections into mice or rats. After slow intravenous injections or after subcutaneous injections the L(+)– isomer however was less toxic than the D(-) – isomer. This might at least partly be explained by the results obtained from other experiments, which demonstrated that after slow infusions of the drugs into rabbits more L(+)–mepivacaine than D(-)–mepivacaine was taken up by the lungs, thus reducing the concentration of the drug reaching the brain, where significantly more D(-)– mepivacaine than L(+)–mepivacaine was found. A slow absorption of L(+)–mepivacaine in comparison with D(-)–mepivacaine from the site of injection is demonstrated and might contribute to the differences in subcutaneous toxicity and might also be the cause of the significantly longer duration of infiltration anaesthesia by the L(+)–isomer than by the D(-)–isomer, since the same nerve-blocking effect of the isomers was found in vitro. Bupivacaine: There were significant differences between the toxicity of the bupivacaine isomers when given intravenously and subcutaneously; the D(+)–isomer was more toxic. This as well as the very long duration of infiltration anaesthesia by L(-)–bupivacaine indicate differences in absorption rates between the bupivacaine isomers similar to those demonstrated for the mepivacaine isomers.

240 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
202315
202248
202114
202038
201923
201824