title: Does the combination of 3% mepivacaine plain plus 2% lidocaine with epinephrine improve anesthesia and reduce the pain of anesthetic injection for the inferior alveolar nerve block? A prospective, randomized, double-blind study.
abstract: BACKGROUND
  In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the pain of injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection pain was also studied.
  
  
  METHODS
  One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the pain of injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes.
  
  
  RESULTS
  Success was not significantly different (P > .05) between the 2 combinations. No statistical differences in injection pain or onset times were found.
  
  
  CONCLUSIONS
  The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block.
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: Emily
authors.initials: E
authors.lastname: Lammers
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio. Electronic address: reader.2@osu.edu.
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
authors.affiliation: Division of Oral Biology, The Ohio State University, Columbus, Ohio.
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Sara
authors.initials: S
authors.lastname: Fowler
mesh_terms: D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000295:instrumentation / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001641:Bicuspid / Q000187:drug effects / Q000294:innervation; D003782:Dental Pulp / Q000187:drug effects / Q000294:innervation; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007180:Incisor / Q000187:drug effects / Q000294:innervation; D007267:Injections / Q000295:instrumentation; D008012:Lidocaine / Q000008:administration & dosage*; D008046:Lip / Q000187:drug effects / Q000294:innervation; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008619:Mepivacaine / Q000008:administration & dosage*; D008963:Molar / Q000187:drug effects / Q000294:innervation; D009339:Needles; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods*; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D008619:Mepivacaine; D004837:Epinephrine
keywords: 3% mepivacaine; Inferior alveolar nerve block; injection pain; lidocaine with epinephrine