Specific Local Anesthetics Amides Lidocaine Mepivacaine Prilocaine Bupivacine

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 Dibucaine - serum cholinesterase survey for atypical enzymes normal value : dibucaine number = 66 - 86 abnormal values decreased as low as 20

Esters Procaine Cocaine Benzocaine Tetracaine

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

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

Lidocaine Time to onset Half life Max rec dose (Malamed) (manufac. ) w/o epi with epi 2 -3 mins 90 mins 4. 4 mg/kg (2 mg/lb) 6. 6 mg/kg (3 mg/lb)

Lidocaine Maximum safe dose - 2% with 1: 100, 000 epi Malamed - 300 mg or 8 carpules manufac. - 500 mg or 13. 5 carpules

Mepivacaine Concentration - 2% or 3% Potency - 2 X Procaine Toxicity - 1. 5 -2 X Procaine Metabolized - Liver Excreted - Kidney

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

Mepivacine Time to onset Half life Max rec dose (Malamed) (manufac. ) 1. 5 -2 mins 1. 9 hrs 4. 4 mg/kg (2 mg/lb) 6. 6 mg/kg (3 mg/lb)

Mepivacaine Maximum safe dose - 3% w/o vasoconstrictor Malamed - 300 mg or 5. 5 carpules manufac. - 400 mg or 8 carpules

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

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

Prilocaine % 4 4 Vasoconstrictor Duration without pulp - 10 mins infiltra. 60 mins block tissue - 1. 5 -4 hrs 1: 200, 000 epi pulp - 60 -90 mins tissue - 3 -8 hrs

Prilocaine Time to onset Half life Max rec dose all forms Max safe dose all forms 2 -4 mins 1. 6 hrs 6 mg/kg (2. 7 mg/lb) 400 mg or 5. 5 carpules

Bupivacaine Concentration - 0. 5% Potency - 8 X Procaine (4 X Lidocaine) Toxicity - 8 X Procaine (4 X Lidocaine) Metabolized - Liver Excreted - Kidney

Bupivacaine % 0. 5 Vasoconstrictor 1: 200, 000 epi Duration pulp - 90 -180 mins tissue - 4 -9 hrs, up to 12 hrs reported

Bupivacaine Time to onset Half life Max rec dose Max safe dose 6 -10 mins 2. 7 hrs 1. 3 mg/kg (0. 6 mg/lb) 90 mg or 10 carpules

Etidocaine Concentration - 1. 5% Potency - 8 X Procaine (4 X Lidocaine) Toxicity - 4 -8 X Procaine (2 -4 X Lidocaine) Metabolized - Liver Excreted - Kidney

Etidocaine % 1. 5 Vasoconstrictor 1: 200, 000 epi Duration pulp - 90 -180 mins tissue - 4 -9 hrs

Etidocaine Time to onset Half life Max rec dose Max safe dose 1. 5 -3 mins 2. 6 hrs 8 mg/kg (3. 6 mg/lb) 400 mg or 15 carpules

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

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

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