Can repeated doses of mepivacaine given once a week before dental surgery cause worsening of nausea

Fråga: Can repeated doses of mepivacaine given once a week before dental surgery cause worsening of nausea and feeling of discomfort (non-specific) after each treatment? Some patients were given mepivacaine once a week and experienced after 4-5 injections that the symptoms became even worse after each treatment.

What happens with mepivacaine in the body?

Can mepivacaine be accumulated and cause cumulative side effects?

Sammanfattning: Nausea is a known side effect of treatment with mepivacaine. The feeling of discomfort is non-specific and difficult to evaluate. The feeling of worsening of the symtoms after each dose and treatment can be related to the expected discomfort. An accumulation of mepivacaine seems to be unlikely.

Svar: Mepivacaine is a local anesthetic, highly bound to plasma proteins (78 per cent) and the plasma half-life is 2-3 hours in adults. It is rapidly metabolized in the liver and less than 10 per cent of the dose is excreted in the urine (1). Compared to other local anesthetics mepivacaine is relatively hydrophilic (2).

Based on the known pharmacokinetic properties of mepivacaine and the long time between each treatment accumulation of the drug seems to be unlikely.

Mepivacaine is known to cause nausea. In SADRAC one (possible) nause case is reported with a duration of two days after mepivacaine was given as a local anesthetic before dental surgery. Concerning the feeling of discomfort the reaction is too non-specific to be evaluated (3).