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Home , Propoxycaine

DH 255

LOCAL AGENTS

Review 1. Table 4-2 Contraindications for Local (page 53)

2. chemical structure of “generic” amide and ester molecules

3. Local Anesthetics in Dental Cartridge (available in U.S.A. as of August, 2013)

Lidocaine 2% 4% 2%, epinephrine 1:50,000 Prilocaine 4%, epinephrine 1:200,000 Lidocaine 2%, epinephrine 1:100,000 4%, epinephrine 1:100,000 3% Articaine 4%, epinephrine 1:200,000 Mepivacaine 2%, levonordefrin 1 :20,000 0.5%, epinephrine 1:200,000

4. ** Maximum doses should be decreased for elderly / debilitated (see text pg. 55, paragraph 4)

Amide Class Anesthetics lidocaine (Xylocaine, Octocaine, Lingospan) Onset: Rapid Metabolism: Liver Excretion: Kidneys Concentration: 2% Duration: intermediate (60min / 180-300min)

*Max. Dose: 7.0 mg/ kg body weight 4.4 mg/ kg 3.2 mg/ lb body weight 2.0 mg/ lb 500 mg. absolute max. 300 mg absolute max

mepivacaine (Carbocaine, Isocaine, Polocaine, Scandanest) Onset: Rapid Metabolism: Liver Excretion: Kidneys Concentration: 3% without vasoconstrictor 2% with vasoconstrictor (1:20,000 levonordefrin) Duration: 3% “plain” short (infiltration) (20 min / 120-180min) intermediate? (block) (40 min / 120-180 min) 2%, levo 1:20,000 intermediate (60 min / 180-300)

*Max. Dose: 6.6 mg/ kg body weight 4.4 mg/ kg 3.0 mg/ lb body weight 2.0 mg/kg 400 mg. absolute max. 300 mg absolute max

prilocaine (Citanest) Onset: Moderate Metabolism: Liver / o-toluidine can induce methemoglobinemia prilocaine 4% “plain” Lungs prilocaine 4% epi 1:200,000 Excretion: Kidneys Concentration: 4% Duration: 4% “plain” short (infiltration) (10-15min / 90-120min) intermediate? (block) (40-60min - 120-240min) 4%, epi 1:200,000 intermediate (60-90min - 180-480min)

*Max. Dose: 8.0 mg/ kg body weight 6.0mg/ kg 3.6 mg/ lb body weight 2.7mg /lb 600 mg. absolute max. 400mg absolute max articaine (Septanest, Septocaine,Ultracaine, Articadent, Orabloc, Zorcaine) Onset: Moderate Metabolism: Liver, plasma Excretion: Kidneys Concentration: 4% Duration: 4%, epi 1:100,000 intermediate (60-75min / 180-360min) 4%, epi 1:200,000 intermediate (45-60min/ 120-300min)

*Max. Dose: 7.0 mg/ kg body weight 3.2 mg/ lb body weight no absolute max. (no MRD listed) 500 mg. absolute max. (Dr. Green)

bupivicaine (Marcaine, Vivacaine) Onset: Slow (6-10 minutes) Metabolism: Liver Excretion: Kidneys Concentration: 0.5% Duration: long (90-180min / 240-540)

*Max. Dose: 2.0 mg/ kg body weight 1.3 mg/kg 0.9 mg/ lb body weight 0.6 mg/lb 90 mg absolute max.

(Duranest) NO LONGER AVAILABLE Onset: Rapid Metabolism: Liver Excretion: Kidneys Concentration: 1.5% *Max. Dose: 8.0 mg/ kg body weight 3.6 mg/ lb body weight 400 mg absolute max .

Ester Class Anesthetics NO LONGER AVAILABLE IN DENTAL CARTRIDGE (Novocaine) Onset: Slow (6-10 minutes) Metabolism: Plasma (pseudocholinesterase) PABA Excretion: Kidneys Concentration: 2% *Max. Dose: 6.0 mg/ kg body weight 2.7 mg/ lb body weight 400 mg absolute max.

propoxycaine (Ravocaine) onset: Rapid Metabolism: Plasma Liver Excretion: Kidneys Concentration: 0.4% *Max. Dose 6.6 mg/ kg body weight 3.0 mg/ lb body weight 400 mg absolute max. (of total amine = propoxycaine + procaine)

Topical Anesthetics Vasodilators water solubility Rate of absorption

1. Ester poor water solubility poor absorption *Max. Dose: ?

2. lidocaine hydrochloride Amide Water-soluble *Max. Dose: 200 mg

3. hydrochloride Ester Water-soluble *Max. Dose: 20 mg

4. dyclonine hydrochloride NOT CURRENTLY AVAILABLE (?) ketone (not amide nor ester) slightly soluble in water *Max. Dose: 200 mg

5. EMLA – eutectic mixture (of) local anesthetics

6. Dentipatch

7. Oraquix

Next Week’s Injections:

IA (inferior alveolar nerve block, mandibular block, Halsted block) region anesthetized: needle length: needle gauge: volume of anesthetic: depth of penetration:

LB (long buccal nerve block, buccal nerve block) region anesthetized: needle length: needle gauge: volume of anesthetic: depth of penetration: