Frequency of General Side Reactions after Regional Anaesthesia with Mepivacaine with and without Vasoconstrictors

Dhunèr, K. G.

doi:10.1111/j.1399-6576.1972.tb00596.x

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…produces little, if any, further decrease in maximum local anaesthetic levels. They should, therefore, be avoided in view of side effects associated with excessive systemic concentrations of adrenaline (Dhuner, 1972). Volumes larger than 8ml of I in 80,000 adrenaline are unlikely to be needed for dental procedures (Verrill, 1975).…”

Section: J4 Addition Of Vasoconstriccorsmentioning

confidence: 99%

Clinical Pharmacokinetics of Local Anaesthetics1

Tucker

Mather

1979

Clinical Pharmacokinetics

282

145

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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. System toxicity following injection of local anesthetics 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 pseudocholinesterase 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 contined 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.

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Section: J4 Addition Of Vasoconstriccorsmentioning

confidence: 99%

Clinical Pharmacokinetics of Local Anaesthetics1

Tucker

Mather

1979

Clinical Pharmacokinetics

282

145

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“…A number of prospective studies emphasize the safety and the high success rates of transarterial axillary block using large doses of local anaesthetics containing adrenaline (3,8,9). A retrospective analysis of 30 885 regional anaesthetics employing mepivacaine, reported a very low (0.2%) incidence of systemic reactions, such as agitation, twitching, fainting and convulsions (10). These reactions were not dose related and were not reduced by addition of a vasoconstrictor.…”

Section: Discussionmentioning

confidence: 99%

An unusual toxic reaction to axillary block by mepivacaine with adrenaline

Koscielniak-Nielsen

1998

Acta Anaesthesiol Scand

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An increase in blood pressure, accompanied by atrial fibrillation, agitation, incomprehensible shouts and loss of consciousness, was observed in an elderly, ASA classification group II, cardiovascularly medicated male, 12 min after performance of axillary block with mepivacaine 850 mg containing adrenaline 0.225 mg, for correction of Dupuytren's contracture. After intravenous administration of labetalol, metoprolol and midazolam the patient's condition improved, and 15 min later he woke up. The block was successful and surgery was conducted as scheduled despite persisting atrial fibrillation. Postoperatively, the patient refused DC cardioversion and was treated medically. Both the temporal relationship of events and the response to treatment suggest that a rapid systemic absorption of mepivacaine with adrenaline and/or interaction of these drugs with the patient's cardiovascular medications were responsible for the perioperative complications.

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“…Peripheral venous blood was sampled 5,10,15,20,30,45, and 60 min after completion of local anaesthetic injection. The plasma was separated and frozen until drug concentrations were determined by means of gas chromatographic measurement (HPLC/ UV) (17).…”

Section: Methodsmentioning

confidence: 99%

Plasma prilocaine and mepivacaine concentrations after combined lumbosacral plexus block

Kaiser

Niesel

Biscoping

et al. 1992

Acta Anaesthesiol Scand

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In a pharmacokinetic study of combined sciatic/3-in-1 block for lower limb surgery, the two moderate-acting local anaesthetics prilocaine and mepivacaine were compared. The mean maximum venous plasma concentrations of mepivacaine were more than twice as high as when prilocaine was used as anaesthetic (5.1 micrograms/ml vs. 2.37 micrograms/ml). When used in combination with the former, ornipressin did not reduce plasma concentrations of mepivacaine to values which were below the threshold for toxic symptoms (5-6 mg/ml). The peak plasma concentrations exceeded the threshold of 5 micrograms/ml in four of the nine patients of the mepivacaine group (maximum value 7.21 mg/ml) and in two of the nine patients of the mepivacaine+ornipressin group (maximum value 8.61 micrograms/ml).

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Frequency of General Side Reactions after Regional Anaesthesia with Mepivacaine with and without Vasoconstrictors

Cited by 10 publications

References 23 publications

Clinical Pharmacokinetics of Local Anaesthetics1

Clinical Pharmacokinetics of Local Anaesthetics1

An unusual toxic reaction to axillary block by mepivacaine with adrenaline

Plasma prilocaine and mepivacaine concentrations after combined lumbosacral plexus block

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