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Classification of Local Anesthetics
Classification of Local Anesthetics
ANESTHETICS
By
I. Ester group
A. Benzoic acid esters
1. Cocaine (topical only) naturally
occurring
2. Benzocaine (topical only)
Chemical Groups of LOCAL ANESTHETICS
commonly used in dentistry:
Dosage
Due to its extremely poor solubility in
water and poor absorption, toxic
reactions to benzocaine are almost
unknown
Benzocaine
Preparation:
Extremely poor water solubility – not
suitable for injection; available only in
topical preparations
Available in number of concentrations
up to 20% and in combination with other
agents
Different flavors have been added to
benzocaine gel to make them
particularly popular with children
Benzocaine
Recommended uses in Dentistry:
Topical application prior to an
infiltration – means of reducing pain
Incorporated into proprietary
medications for application to painful
intraoral lesions – ulcers
Sole source of anesthesia for
superficial soft tissue manipulation
Procaine
Produced synthetically procaine
hydrochloride by two Swedish chemists,
Alfred Einhorn & E. Uhlfelder
Tested clinically by Henrich Braun and
marketed as Novocaine (proprietary
name)
Archetypal dental local anesthetic prior
to the introduction of lignocaine
Procaine
Duration of action
When injected, plain 0.15% solution will
produce 30 – 45 minutes of analgesia
Same concentration with 1:100,000
epinephrine will produce 75 – 120
minutes of analgesia
Tetracaine
Recommended use in Dentistry
Although efective when given by
injection, it is not used in this manner
due to its toxicity.
It is available in topical preparations
both on its own and in combination with
other anesthetic agents such as
lignocaine
Propoxycaine (Ravocaine)
2-diethylaminoethyl 4-amino-2-
propoxybenzoate is its chemical name
Equal in potency and toxicity to
tetracaine
Preparation
Not used alone in dentistry, combined
with procaine, in a procaine 2%,
propoxycaine 0.4% solution with either
1:20,000 levondefrin or 1: 30,000
levarterenol as vasoconstrictor
Propoxycaine
Duration of action
Combination of procaine and propoxycaine
gives rapid and profound anesthesia with
a pulpal analgesia of about 1 – 1.5 hours
and soft tissue duration of 2 – 3 hours
Dosage
Suggested maximum dose is 6.6 mg’kg (3
mg/lb)
Maximum total anesthetic (procaine plus
propoxycaine) dosage should not exceed
400 mg
2-Chloroprocaine
Proprietary name: Nesacaine
Beta-diethylaminoethyl-2-chloro-4-
aminobenzoate (chemical name)
Differs from other local anesthetic of
the ester group in having a chloride
atom substituted in the benzene ring
2x as potent but less toxic than
procaine – hydrolyzed 4x-5x faster than
procaine
2-Chloroprocaine
Preparation
Not available in dental cartridge,
multiple dose vial via disposable 3 to 5
cc syringe with a 25-gauge Leur-Lok
needle
Available in 1.2% or 3% concentrations,
must be used with a vasoconstrictor due
to its shortness of duration
2-Chloroprocaine
Preparations
3% plain solution
2% solution with 1:80,000
adrenaline
Not available in a topical
preparation
Mepivacaine
Recommended use in Dentistry:
Prime indication is for the use is when
vasoconstrictor-free solution must be
employed as 3% mepivacaine is more
effective than plain lignocaine or
prilocaine solutions
Solution with adrenaline has identical
indications for use as lignocaine with
adrenaline although it has a shorter
duration of action
Mepivacaine
Anesthetic Max. Max. dose Max. dose Max. dose Max. dose
solution dose of 1.8 ml of 1.8 ml of 2.2 ml of 2.2 ml
(mg/kg) cartridges cartridges in cartridges cartridges in
[absolute in an adult a 5-year-old in an adult a 5-year-old
ceiling of 70 kg child of 20kg of 70 kg child of 20kg
(mg)]
2% lignocaine 4.4 [300] 8.3 2.4 6.8 2
Preparations:
Dental local anesthetic cartridges as
1.5% solution with 1:200,000 adrenaline