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Mylotat is a brand name for **mepivacaine**. ## Overview Mepivacaine is a local anesthetic of the aminoamide class. It blocks nerve impulse conduction by decreasing the permeability of the neuronal membrane to sodium ions. ## Primary Indications * Local infiltration anesthesia * Peripheral nerve blocks * Epidural anesthesia * Intra-articular anesthesia ## Adult Dosing Dosage varies significantly based on the site and duration of anesthesia. * **Local Infiltration:** Typically 0.5% to 2% solution. Usual dose 100-200 mg. Maximum dose without epinephrine: 300 mg. Maximum dose with epinephrine: 500 mg. * **Peripheral Nerve Blocks:** Typically 1% to 2% solution. Usual dose 50-150 mg. * **Epidural Anesthesia:** Typically 1% to 2% solution. Initial dose 75-150 mg. Incremental doses of 25-50 mg may be given. Maximum dose: 300 mg in 2 hours. * **Intra-articular Anesthesia:** Typically 1% solution. Usual dose 50-100 mg. Specific dosages are often guided by institutional protocols and surgeon/anesthesiologist preference. ## Pediatric Dosing Data for pediatric use is limited. Dosing should be individualized based on patient weight, age, and the procedure. * **Local infiltration and minor nerve blocks:** Concentration of 0.5% to 1% is often used. Total dose should not exceed 3 mg/kg. ## Dose Adjustments * **Hepatic Impairment:** Reduced doses may be necessary due to impaired metabolism. * **Renal Impairment:** No significant dose adjustment is typically required, but caution is advised, especially in severe impairment, as metabolites can accumulate. * **Elderly Patients:** May be more sensitive to systemic effects; consider reduced doses. * **Debilitated or Acutely Ill Patients:** Require reduced doses. ## Contraindications * Hypersensitivity to mepivacaine or other amide-type local anesthetics. * Severe shock or heart block (patients with pre-existing serious cardiac abnormalities). ## Adverse Effects Common adverse effects are generally related to systemic absorption and CNS/cardiovascular toxicity. * **CNS:** Dizziness, lightheadedness, circumoral numbness, tingling, blurred vision, tinnitus, restlessness, anxiety, tremors, seizures, respiratory depression, coma. * **Cardiovascular:** Hypotension, bradycardia, arrhythmias, cardiac arrest. * **Other:** Nausea, vomiting, allergic reactions (rare). ## Key Drug Interactions * **Class I Antiarrhythmics (e.g., tocainide, mexiletine):** Additive toxicity. * **Opioid Analgesics:** May potentiate respiratory depression. * **Vasoconstrictors (e.g., epinephrine):** Can prolong duration and reduce systemic absorption, but increases risk of local ischemia at high concentrations. ## Monitoring * Vital signs (heart rate, blood pressure, respiratory rate). * Level of anesthesia. * Signs of systemic toxicity (CNS and cardiovascular changes). ## Clinical Pearls * Mepivacaine has a relatively rapid onset and intermediate duration of action. * Mepivacaine 2% without epinephrine is a common choice for dental procedures. * The risk of systemic toxicity increases with higher doses, faster injection rates, and unintentional intravascular injection. * Aspiration for blood before injection is crucial to minimize risk of intravascular injection. *** *This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions.*