title: Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.
abstract: OBJECTIVE
  The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.
  
  
  METHODS
  Through use of a repeated-measures design, each of 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were (1) an inferior alveolar nerve block (with 1.8 mL of 3% mepivacaine) + intraosseous injection with 1.8 mL of 3% mepivacaine and (2) an inferior alveolar nerve (with 1. 8 mL of 3% mepivacaine) + mock intraosseous injection. The first molar was blindly pulp tested at 2-minute cycles for 60 minutes postinjection. Anesthesia was considered successful with 2 consecutive 80 readings. Heart rate (pulse rate) was measured with a pulse oximeter.
  
  
  RESULTS
  All subjects had lip numbness with both of the inferior alveolar nerve + intraosseous techniques. Anesthetic success for the first molar was significantly increased for 30 minutes with intraosseous injection of mepivacaine in comparison with the inferior alveolar nerve block alone (mock intraosseous injection). Subjects receiving the intraosseous injection of mepivacaine experienced minimal increases in heart rate.
  
  
  CONCLUSIONS
  The intraosseous injection of 1.8 mL of 3% mepivacaine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success for 30 minutes in the first molar. The 3% mepivacaine had a minimal effect on heart rate and would be useful in patients with contraindications to epinephrine use.
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus 43210, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gallatin
authors.forename: P
authors.initials: P
authors.lastname: Stabile
authors.forename: A
authors.initials: A
authors.lastname: Reader
authors.forename: R
authors.initials: R
authors.lastname: Nist
authors.forename: M
authors.initials: M
authors.lastname: Beck
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D003791:Dental Pulp Test / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D017148:Infusions, Intraosseous; D008297:Male; D008340:Mandibular Nerve; D008619:Mepivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D009407:Nerve Block / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D008619:Mepivacaine