Duration of experimental nerve block by combinations of local anesthetic agents

Abstract

The effects of bupivacaine-prilocaine and meperidine-lidocaine combinations (as compared with those of the agents used alone) on the duration of peripheral sensory nerve block were studied with the infraorbital nerve block model (IONB) in the rat, and those on motor block with spinal anesthesia (SA) in the mouse. The duration of bupivacaine-induced IONB was invariably prolonged when prilocaine was included in the solution. When included in 0.125% bupivacaine, 1.0% prilocaine had a slightly less pronounced enhancing effect than 0.5% prilocaine (24-57% vs. 74%-104%, respectively). The duration of IONB with 1.0% prilocaine was significantly reduced (14-37%) by inclusion of 0.125% bupivacaine. In SA, inclusion in 0.125% bupivacaine of prilocaine (0.5% or 1.0%) prolonged motor block by 128% and 192%, respectively. When included in 0.25% bupivacaine, both 0.5% and 1.0% prilocaine significantly reduced the duration of SA, by 42% and 37%, respectively. With one exception, the duration of IONB by meperidine was significantly shortened (< 44%) when lidocaine was included in the solution. In SA, inclusion of 2% lidocaine with 2% meperidine did not affect the duration of meperidine-induced motor block. The duration of SA obtained with the combination of 4% lidocaine and 4% meperidine was 45% shorter than that induced by 4% meperidine alone. The reasons for these variable effects are not clear, but may be due to interaction or antagonism at any of multiple sites.

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis

“…Maurette et al (20) also found a synergistic effect when meperidine was used in combination with a local anesthetic. However, Hassan et al (15) suggested there might be an interaction or antagonism between local anesthetic receptor sites because of their finding that the duration of an infraorbital nerve block was significantly shortened when meperidine was combined with lidocaine. Two factors may account for a lower incidence of anesthetic efficacy with the combination lidocaine/meperidine.…”

“…A number of clinical and experimental studies (10 -22) have shown that meperidine induces spinal anesthesia and blocks action potentials, providing segmental and sensory blocks comparable in effect to lidocaine. In medicine, it has been administered intrathecally (8,10,14,16,18), spinally (13,20), and as a saddle block (11), as well as locally for intravenous regional anesthesia (21), block (15), and infiltration (22) for the effects of analgesia, anesthesia, or both.…”

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks

“…In evaluating anesthetic success and the incidence of pulpal anesthesia ( Figures 2 through 7), it can be seen that generally the duration of pulpal anesthesia begins to decrease after about 15 minutes, which accounts for a great deal of the problem with anesthetic success. Hassan and colleagues 29 found that the duration of a block was significantly shortened when lidocaine was introduced into a solution of meperidine. They felt the decreased duration was caused by interaction or antagonism at drug receptors in the nerve membrane or at nonspecific binding sites.…”

“…22 Clinically, meperidine has local anesthetic activity. A number of clinical and experimental studies [24][25][26][27][28][29][30][31][32][33][34][35][36] have shown that meperidine induces spinal anesthesia and blocks action potentials, providing segmental and sensory blocks comparable to those provided by lidocaine. In medicine, it has been administered intrathecally, 22,24,28,30,32 spinally, 27,34 and as a saddle block, 25 as well as locally for intravenous regional anesthesia, 35 block, 29 and infiltration 36 for the effects of analgesia, anesthesia, or both.…”

Anesthetic Efficacy of Meperidine in Teeth With Symptomatic Irreversible Pulpitis

“…Using mouse models, Hassan et al 35 found a reduced duration (less than 44%) of inferior orbital nerve block when lidocaine was added to meperidine compared to the nerve block with meperidine alone. On the other hand, mast cells are a potential important site for the histamine-dependent, peripheral actions of meperidine.…”