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2. Chemical Structure of 3 DH 255 LOCAL ANESTHETIC AGENTS Review 1. Table 4-2 Contraindications for Local Anesthetics (page 53) 2. chemical structure of “generic” amide and ester local anesthetic molecules 3. Local Anesthetics in Dental Cartridge (available in U.S.A. as of August, 2013) Lidocaine 2% Prilocaine 4% Lidocaine 2%, epinephrine 1:50,000 Prilocaine 4%, epinephrine 1:200,000 Lidocaine 2%, epinephrine 1:100,000 Articaine 4%, epinephrine 1:100,000 Mepivacaine 3% Articaine 4%, epinephrine 1:200,000 Mepivacaine 2%, levonordefrin 1 :20,000 Bupivacaine 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. etidocaine (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 procaine (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. benzocaine Ester poor water solubility poor absorption *Max. Dose: ? 2. lidocaine hydrochloride Amide Water-soluble *Max. Dose: 200 mg 3. tetracaine 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: .
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