Anesthetic Solutions

Classification of local anesthetics

a. ESTERS
b. AMIDES
of para-aminobenzoic acid:
➢ lidocaine (lignocaine, xylocaine)
⮚ Procaine(novocaine, necoina)
➢ bupivacaine
⮚ Chlorprocaine(nesacaine)
➢ etidocaine
⮚ Propoxycaine
➢ ropivacaine
➢ articaine
of benzoic acid
➢ dibucaine (cincochaine)
⮚ Cocaine
➢ mepivacaine (carbocaine)
⮚ Tetracaine (pantocaine)
➢ prilocaine (citanest)
⮚ Benzocaine
⮚ Piperocaine
⮚ Hexylcaine c. QUINOLINE
⮚ Butacaine ⮚ Centbucridine
 The DURATION of local ANESTHESIA
The anesthesia duration of the hard tissue (tooth pulp) and the soft tissue (total) for each substance is
approximate. There are many factors which affect both depth and duration of action of anestethic
substances

1. The individual body answer at the anesthetic substance

2. Accuracy in anesthetic deposition
3. The condition of the tissues at the site of anesthetic deposition
4. Anatomical variations
5. The type of injection given (supraperiosteal or trunk blocks)
The DURATION of local ANESTHETICS
 LIDOCAINE HYDROCHLORIDE(Xilina in RO)
Potency: 2 (compared with procaine)

Metabolized : in the liver

Excretion: kidneys

Vasodilating properties: Much smaller than procaine ; however, much bigger than the vasodilating properties of prilocaine or mepivacaine

Installation: in 3-5 minutes

Effective dental concentration: 2%

Half life: 1.6 hours (almost 90 minutes)

Topical action of anesthetic: yes (5% concentrations)

Toxicity class: B

Lactation: safe

Maximum recommended dose :ADULTS - 7.0 mg/kgc, max. 500 mg; CHILDREN –4.5mg/kgc

Allergic reactions: very rare

 MEPIVACAINE HYDROCLORIDE
Potency: 2

Metabolized : in the liver

Excretion: kidneys

Vasodilating properties: mild vasodilation

Installation: in 3-5 minutes

Effective dental concentration: 3% (without vasoconstrictive), 2% (with vasoconstrictive)

Half life: 1.9 hours

Topical action of anesthetic: no

Toxicity class: C (it is forbidden to use in the first quarter of pregnacy)

Lactation: safe

Maximum recommended dose :ADULTS - 6.6 mg/kgc, max. 400mg;

Allergic reactions: very rare

MEPIVACAINE HYDROCLORIDE
 ARTICAINE HYDROCHLORIDE
Potency: 1.5 compared to lidocaine

Metabolized : in the liver

Excretion: kidneys

Vasodilating properties: similar to lidocaine

Installation: in 1-9 minutes (the pulp anesthesia last for 1 hour in the case of infiltrations and 2h for trunk blocks)

Effective dental concentration: 4% (with epinephrine 1:100000 or 1:200000)

Half life:0.5 hours (27 minutes)

Topical action of anesthetic: no

Toxicity class: C (it is forbidden to use in the first quarter of pregnacy)

Lactation: the nursing mothers can choose to pump and throw up the milk the first 4hours after the anesthesia -

based on the half life

Maximum recommended dose :ADULTS -7.0 mg/kgc, max. 500mg;

Allergic reactions: very rare

ARTICAINE HYDROCHLORIDE
 Choosing the anesthetic substance
according to

1. The period of time we need to control the pain

2. The need to control postoperative pain

3. The need of hemostasis

4. Exist or not contraindications of using local

anesthetics

3% mepivacaine, could be used

for nontraumatic procedures
Oraverse (phentolamine mesylate) – it’s the reversal
agent of local anesthetics

In clinical trials, the average time of the recovery of normal sensation in the upper lip was 50 minutes for

patients with OraVerse, compared with 133 minutes for the control group and for the lower lip was 70

minutes for patients with OraVerse, compared with 155 minutes for the control group.
Contraindications of local anesthetics
Maximum recommended Dose
 How to calculate the maximum dose and the
number of cartridges
Patient: 40 years,healthy, man, 90 kg
Local anesthetic : articaine hydrochloride + epinephrine 1: 200.000
Articaine, 4% = 72 mg per ampoule
Articaine, 7,0 mg / kg = > 630 mg (maximum recommended dose) (7mg*90kg)
Number of ampules 630/72 ≈ 9.0

Patient: 6 years, healthy, man, 20 kg

Local anesthetic: mepivacaine hydrochloride, without vasoconstrictor
Mepivacaine, 3% = 54 mg per ampoule
Mepivacaine, 6,6 mg / kg = 132 mg (maximum recommended dose)
Number of cartridge 130/54 ≈ 2.5
How to calculate the maximum dose and the number of
cartridges (multiple anesthetic substances)
Patient : woman, 45 kg, healthy
Local anesthetic: mepivacaine, 2%, with levonordefrin 1: 20.000
Mepivacaine, 2% = 36 mg per cartridge
Mepivacaine, 6,6 mg / kg = 297 mg (maximum recommended dose)
The patient recive 2 cartridges (72 mg), but the anesthesia in ineffective
The doctor wants to use articaine 4% with epinephrine 1:100000
How much articaine could be administrated to the patient?
Articaine, 4% = 72 mg per cartridge
Articaine, 7,0 mg / kg = 315 mg (maximum recommended dose)
The total dose of both local anesthetic should not exceed the lower of the two calculated dose 297 mg.
The patient recived 72mg (mepivacaine) so, he could recive 225mg of articaine.
Thus, 225mg/72mg per cartridge is equivalent with 3.0 cartridges of 4% articaine with epinephrine 1:00000.