Mepivacaine for Surgery
Mepivacaine is a local anesthetic that is used to block sensation and pain during surgery, often as spinal anesthesia. It is also used in dental surgery. There are several local anesthetics available that fulfill the same roles, such as bupivacaine, but each has a specific pharmacological profile.
Research conducted by Schwenk et al. found that mepivacaine is superior to bupivacaine in hip arthroplasty (joint surgery of the hip). The former enables earlier ambulation during recovery from spinal anesthesia. This difference is observed because bupivacaine causes greater sensory impairment, thereby delaying ambulation and discharge. 1
Another study compared mepivacaine and bupivacaine during egg retrieval. Spinal anesthesia can be used for oocyte retrieval since there is an increased chance for fertilization (27%) compared to general anesthesia (15%). During transvaginal oocyte retrieval, patients received the spinal mepivacaine–fentanyl combination instead of the traditional bupivacaine—fentanyl combination. Menshawi & Fahim found that the cocktail of mepivacaine was superior to the one with bupivacaine as the primary agent. Recovery from mepivacaine was faster than bupivacaine. Both the sensory and motor block resolved quickly enough to reduce the time to ambulation and hospital discharge.
Calkins et al. arrived at the same conclusion as both of the previous studies. Their research also showed that mepivacaine leads to faster recovery in patients following hip arthroplasty. In addition to shorter stays in the post-acute care units, patients did not experience complications, like urinary catheterization, or require overnight stay. On the other hand, the bupivacaine group experienced more neurologic complications like spinal headache. This data agrees that using mepivacaine spinal anesthesia improves surgery results.
Mepivacaine is also used in dental surgery and is typically administered as a 3% solution without any vasoconstrictors or as a 2% solution with vasoconstrictors such as 1:20,000 levonordefrin and 1:100,000 adrenaline. Lidocaine, another local anesthetic commonly used in dental procedures, is always available as a 2% solution with 1:100,000 or 1:50,000 adrenaline. Su et al. found that the 2% solution of mepivacaine with 1:100,000 adrenaline was far superior to its counterpart lidocaine with 1:100,000 adrenaline. This may be because mepivacaine’s low vasodilation reduced bleeding and systematic toxicity while improving the depth and duration of anesthesia. Milder vasodilation facilitates higher concentrations of mepivacaine. Although the superior effects of mepivacaine to lidocaine was in the context of its combination with vasoconstrictors like adrenaline, the results are still notable. Because anesthesia tends to use cocktails during surgery, examining the drug of impact within its cocktail mixture makes for a more accurate representation of how its results will play out in the field. 3
In dental surgeries, articaine has been proven to produce anesthesia more swiftly compared to mepivacaine. Articaine’s thiophene ring allows for enhanced lipid membrane permeability and metabolism in the plasma of cells enhances the efficacy of the drug. 4 On the other hand, mepivacaine is an amide so needs to be initially metabolized in the liver. Both mepivacaine and articaine block sodium channels on nerve membranes, thereby blocking the transmission of nerve impulses. The literature agrees that the following advantages of mepivacaine make it the number one choice for surgeons: rapid onset so that anesthesia is delivered in a short time, intermediate duration for faster recovery, less vasodilation thereby reducing toxicity, less cardiotoxicity than bupivacaine and it is usable without epinephrine for patients who have contraindications to vasoconstrictors (e.g., certain heart conditions).
References
1. Schwenk ES, Kasper VP, Smoker JD, Mendelson AM, Austin MS, Brown SA, Hozack WJ, Cohen AJ, Li JJ, Wahal CS, Baratta JL, Torjman MC, Nemeth AC, Czerwinski EE. Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation. Anesthesiology. 2020 Oct 1;133(4):801-811. doi: 10.1097/ALN.0000000000003480. PMID: 32852904.
2. Menshawi, M.A., Fahim, H.M. Spinal mepivacaine versus bupivacaine for ultrasound guided transvaginal oocyte retrieval. A comparative study. Ain-Shams J Anesthesiol 12, 22 (2020). https://doi.org/10.1186/s42077-020-00068-9
3. Su N, Liu Y, Yang X, Shi Z, Huang Y. Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Apr;64(2):96-107. doi: 10.1111/idj.12087. Epub 2014 Jan 16. PMID: 24428507; PMCID: PMC9376404.
4.Gazal G. Is Articaine More Potent than Mepivacaine for Use in Oral Surgery? J Oral Maxillofac Res. 2018 Sep 30;9(3):e5. doi: 10.5037/jomr.2018.9305. PMID: 30429965; PMCID: PMC6225598.