Mepivacaine

Careful and constant monitoring of the patient's state of consciousness should be done following each local anesthetic injection; at such times, restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of CNS toxicity. Treatment is primarily symptomatic and supportive.

May potentially trigger malignant hyperthermia; follow standard protocol for identification and treatment.

Continuous intra-articular infusion of local anesthetics after arthroscopic or other surgical procedures is not an approved use; chondrolysis (primarily in the shoulder joint) has occurred following infusion, with some cases requiring arthroplasty or shoulder replacement.

Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment.

Local anesthetics have been associated with rare occurrences of sudden respiratory arrest.

Convulsions due to systemic toxicity leading to cardiac arrest have also been reported, presumably following unintentional intravascular injection. Disease-related concerns:

Use with caution in patients with cardiovascular disease, including rhythm disturbances, shock, heart block, and hypotension.

Use with caution in patients with hepatic impairment. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing, toxic plasma concentrations.

Use with caution in patients with renal impairment. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Use with caution in acutely ill patients; reduce dose consistent with age and physical status.

Use with caution in debilitated patients; reduce dose consistent with age and physical status.

Use with caution in the elderly; reduce dose consistent with age and physical status.

Use with caution in children; reduce dose consistent with age and physical status. Dosage form specific issues:

Do not use solutions containing preservatives for caudal or epidural block. Other warnings/precautions:

Intravascular injections should be avoided; aspiration should be performed prior to administration; the needle must be repositioned until no return of blood can be elicited by aspiration; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Use with caution when there is inflammation and/or sepsis in the region of the proposed injection.

To avoid serious adverse effects and high plasma levels, the lowest dosage resulting in effective anesthesia should be administered. Repeated doses may cause significant increases in blood levels with each repeated dose due to the possibility of accumulation of the drug or its metabolites. Tolerance to elevated blood levels varies with patient status.

A test dose is recommended prior to epidural administration and all reinforcing doses with continuous catheter technique.

Clinicians using local anesthetic agents should be well trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.