Instructions for use of the anesthetic Scandonest in pediatric and adult dentistry

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Scandonest is an anesthetic for pain relief during dental treatment (therapeutic, surgical).

The drug is used by adults and children of all ages. The dosage is calculated by the doctor taking into account the medical history and body weight (in the child).

Drug review

The main active ingredient is mepivacaine hydrochloride. A distinctive feature of the regional anesthetic is its immediate action relative to other groups of anesthetics (procaine, novocaine).

Local insensitivity to pain begins to appear the first minute after administration of the drug, the effect is rapid and long-lasting.

Additional components in the solution:

• sodium hydroxide – a buffering agent to give the desired pH level;
• sodium chloride is the basis for the production of solutions for parenteral administration;
• water for injections.

Scandonest in dental practice is used for infiltration (blockade of receptors and small nerves) and conduction (blockade of nerve plexuses, trunks) anesthesia.

The mechanism of action is blocking stress-dependent sodium channels of nerve membranes, inhibiting the conduction of nerve impulses of sensory, motor, and autonomic nerve fibers.

Initially, the substance penetrates the nerve membrane into the nerve cell itself. There it enters into a chemical bond with a proton, forming an active form, and begins to act.

The substance is quickly distributed in soft tissues. It breaks down into metabolites in the liver and is excreted by the kidneys with urine, intestines with bile, 10% unchanged.

Duration of anesthesia:

• for infiltration use in the area of ​​the pulp of the upper jaw - 25-35 minutes;
• after injection into the mandibular alveolar nerve – 40-50 minutes;
• anesthesia of soft tissues on both jaws lasts 1.5-2.5 hours.

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At this address https://www.vash-dentist.ru/lechenie/zubyi/schitayutsya-intaktnyimi.html we will consider the indications for opening the cavity of an intact tooth.

Cost of anesthetics and anesthesia

The cost of one carpule of anesthetic is approximately 10-20 UAH. Carrying out one anesthesia in a dental clinic will cost an average of 130 UAH.

What to do if you are afraid of anesthesia

Many people are afraid of injections, because each person has their own pain sensitivity threshold. During anesthesia, the pain from the injection may depend on the professionalism of the doctor, the anesthesia technique, and also on the speed of administration of the anesthetic. An experienced doctor does not save time and administers painkillers for at least 40 seconds. Immediately before the injection, you can ask the doctor to treat the area of ​​the upcoming injection with an anesthetic spray (for example, Lidocaine spray).

Use for children

Scandonest is used in pediatric dentistry from the age of 4 years. One of the recommendations for using this drug in children is that it does not contain preservatives.

This minimizes the risk of developing a polyvalent allergy during short-term interventions - removal of a baby tooth, treatment of uncomplicated caries, vital pulpotomy (removal of coronal pulp during inflammation) on temporary or permanent teeth. Anesthesia with a solution is indicated for plastic surgery of the frenulum of the tongue using a laser technique.

When using local anesthetics of different groups and Scandonest, a child may experience additive toxicity - total toxicity when several drugs are combined.

This effect is not diagnosed in adults. Although the concentration of the substance in plasma does not increase, this fact should be taken into account when administering local anesthesia in children.

Contraindications

• Known allergy to local anesthetic solutions belonging to the same chemical group.

Contraindications associated with the use of mepivacaine hydrochloride:

• severe myasthenia gravis;
• low levels of cholinesterases in plasma;
• serious liver dysfunction: cirrhosis, hereditary or acquired porphyria.

Attention athletes! Scandonest contains an active substance that may cause a positive reaction during anti-doping control.

Impact on the ability to drive vehicles or use machinery.

There were no effects of SCANDONEST 3% on vigilance, reaction time to visual stimulation or motor coordination in the studies.

Main incompatibilities: antiarrhythmic drugs (tocainide, etc.).

Indications and restrictions

Indications for the use of Scandonest for local anesthesia:

• treatment of superficial, medium, deep, complicated, generalized caries;
• removal of the nerve, filling of passable and impassable canals;
• simple removal of teeth, including milk teeth, 8th;
• atypical removal;
• opening of periodontal abscess, periostitis;
• resection of the root apex;
• hemisection – removal of one root from a multi-rooted tooth;
• coronary-radicular separation – dissection of the crown and trunk of the tooth for further treatment;
• treatment of periodontitis, alveolitis;
• excision of hypertrophied papillae;
• plastic surgery of the frenulum of the lip and tongue;
• installing or removing a pin;
• preparation of the cavity, treatment of the tooth stump before installing an orthopedic structure, aesthetic restoration.

The anesthetic is not used for patients with high hypersensitivity to the active substance.

Absolute contraindications are severe hypertension, acute heart failure, hereditary metabolic pathology.

Scandonest should not be used by people with a history of malignant hyperthermia - a life-threatening condition that develops after general anesthesia (oxidation of the body, continuous muscle spasm, high temperature).

Local anesthesia is not recommended for drug-uncontrolled epilepsy.

Medications to relieve fear and anxiety before visiting the dentist

There are many sedatives that reduce anxiety, one of which is Afobazole. This drug does not have a hypnotic effect, however, for positive results, you should start drinking it a week before the expected visit to the dentist.

Cheaper drugs (Corvalol, valerian extract, etc.) should be started three days before visiting the doctor, but these drugs in high doses can lead to weakness, drowsiness and decreased performance.

Also, in many clinics you can be given premedication - the administration of sedatives intramuscularly half an hour before dental procedures. Such drugs are classified as tranquilizers and are available by prescription (Seduxen, Relanium, etc.).

Dosage regimen and side effects

The drug is used exclusively in the field of dentistry. Adults are administered from 1 to 4 ml, depending on the complexity and duration of the upcoming treatment.

In children over 4 years of age and weighing 20-30 kg, the analgesic effect occurs with the introduction of 0.25-1 ml; with a weight of 30-40 kg, 0.5-2 ml will be needed. On average, the dosage is calculated using the following formula: 0.75 mg of active substance per 1 kg of weight, which equals 0.025 ml/kg.

An elderly person remains at risk of high concentrations of Scandonest in plasma due to slow metabolic processes, low distribution of the anesthetic, and general weakening of the body.

In these cases, it is recommended to reduce the dosage and not perform repeated injections (additional anesthesia). A dose reduction is mandatory in people with chronic heart and vascular diseases (angina pectoris, arteriosclerosis).

The maximum single dose for healthy adults is 4 mg/kg, which corresponds to 0.133 ml/kg. This means that a person weighing 70 kg is allowed a single injection of 300 mg of mepivacaine (10 ml of Scandonest).

For a child over 4 years of age, the required volume is calculated based on body weight, age, and duration of therapeutic or surgical manipulation. The equivalent of 3 mg/kg or 0.1 ml/kg should not be exceeded.

Attention! The main reasons for possible side effects are excessive dosage, slow metabolic processes, rapid absorption of the solution, unintentional injection into the lumen of a blood vessel.

Severe complications of local anesthesia develop extremely rarely and manifest themselves in the nervous system:

• neuralgic pain, damage to part of the peripheral nerve, root, plexus;
• paresthesia – burning, tingling, tingling, numbness, sensation of heat or cold, itching, malfunction of taste buds, metallic taste in the mouth;
• depression or stimulation of the nervous system;
• headache, dizziness, impaired consciousness, drowsiness;
• muscle tremors, partial paralysis, drooping eyelids, fainting, respiratory arrest;
• disorientation in space, impaired coordination, diction;
• with deep depression of the central nervous system - loss of consciousness, convulsions, coma.

The drug can depress the activity of the cardiovascular system - slow down or increase heart rate, provoke arrhythmia, increased blood pressure, and atrial fibrillation.

In severe cases, the conduction of the heart muscle is disrupted, acute cardiovascular failure develops, which can provoke cardiac arrest. This condition is preceded by increased sweating, dizziness, severe weakness, and changes in heart rate.

Other possible side effects:

• slow or frequent movement of the chest , respiratory depression until it stops for 1-2 minutes, hoarseness in the voice, decreased oxygen and increased carbon dioxide in the body;
• allergic reactions - itching, redness, peeling of the skin, rashes, urticaria, swelling of the tongue, mucous membranes of the upper respiratory system, face, increased body temperature, bronchospasm;
• nausea, single vomiting not associated with food intake, stomatitis, gingivitis, glossitis (inflammation of the tongue);
• muscle twitching, chills , swelling at the site of anesthetic injection, chest pain, weakness, fatigue, fever.

Experience in the clinical use of local anesthetics based on mepivacaine

A. V. Kuzin

Candidate of Medical Sciences, dental surgeon of the Federal State Institution "Central Research Institute of Infrastructure and Maxillofacial Surgery" of the Ministry of Health of the Russian Federation, consultant physician at 3M ESPE on pain management in dentistry

M. V. Stafeeva

dentist-therapist, private practice (Moscow)

V. V. Voronkova

Candidate of Medical Sciences, Dentist-Therapist, Department of Therapeutic Dentistry, Clinical Diagnostic Ministry of Health of Russia

Often in clinical practice there is a need to use short-acting anesthetics. There are many low-volume dental procedures that require pain relief. The use of long-acting anesthetics is not entirely legal, since the patient leaves the dentist with numbness in a certain area of ​​the oral cavity lasting from 2 to 6 hours.

Taking into account the labor and social load on the patient, the use of short-acting anesthetics is justified, which can reduce the duration of soft tissue numbness to 30-45 minutes. Today in dentistry, local anesthetics based on mepivacaine meet these requirements.

Mepivacaine is the only amide anesthetic that can be used without the addition of a vasoconstrictor. Most amide anesthetics (articaine, lidocaine) dilate the blood vessels at the injection site, which leads to their rapid absorption into the bloodstream. This shortens the duration of their action, which is why dosage forms of anesthetics are available with epinephrine. In the Russian Federation, lidocaine is produced in ampoules without vasoconstrictors, which requires its dilution with epinephrine before use. According to modern standards of pain management in dentistry, the preparation of a local anesthetic solution by staff is a violation of the anesthesia technique. 3% mepivacaine has a less pronounced local vasodilator effect, which allows it to be effectively used to anesthetize teeth and soft tissues of the oral cavity (Table No. 1).

The duration of action of mepivacaine-containing anesthetics (mepivastezin) varies in individual areas of the oral cavity. This is due to some features of its pharmacological action and features of the anatomy of the oral cavity. According to the instructions of the local anesthetic, the duration of anesthesia for the dental pulp is on average 45 minutes, anesthesia for soft tissues - up to 90 minutes. These data were obtained as a result of an experimental study in practically healthy patients during anesthesia of single-rooted teeth, mainly in the upper jaw. Naturally, such studies do not reflect real clinical conditions in which a dentist is faced with inflammatory phenomena in tissues, chronic neuropathic pain, and the individual characteristics of the patient’s anatomy. According to domestic scientists, it was found that the average duration of dental pulp anesthesia when using 3% mepivacaine is 20-25 minutes, and the duration of soft tissue anesthesia depends on the volume of anesthetic administered and the anesthesia technique (infiltration, conduction) and is 45-60 min.

An important issue is the speed of onset of local anesthesia. Thus, when using 3% mepivacaine, the rate of onset of dental pulp anesthesia is 5-7 minutes. Therapeutic dental treatment will be most painless for the patient from the 5th to the 20th minute after anesthesia. Surgical treatment will be painless from the 7th to the 20th minute after local anesthesia.

There are some peculiarities in the anesthesia of certain groups of teeth with 3% mepivacaine. Numerous studies have proven that it is most effective in relieving pain in single-rooted teeth. The incisors of the upper and lower jaws are anesthetized with infiltration anesthesia with 3% mepivacaine in a volume of 0.6 ml. In this case, it is important to take into account the topography of the apexes of the roots of the teeth and, accordingly, the depth of advancement of the carpule needle into the tissue. For anesthesia of canines, premolars and molars of the upper jaw, the authors recommend creating an anesthetic depot of 0.8-1.2 ml. Mandibular premolars respond well to anesthesia with 3% mepivacaine: submental anesthesia is performed in various modifications, where an anesthetic depot of up to 0.8 ml is created. It is important after submental anesthesia to apply digital pressure to the soft tissues above the mental foramen for better diffusion of the anesthetic. Infiltration anesthesia in the area of ​​mandibular molars with 3% mepivacaine is ineffective compared to articaine. Anesthesia of mandibular molars with 3% mepivacaine is advisable only in patients with contraindications to the use of articaine-containing anesthetics with epinephrine: in these cases, mandibular anesthesia (1.7 ml of 3% mepivacaine) must be performed. Mandibular canines are also anesthetized with chin or mandibular anesthesia in patients with the contraindications described above.

As a result of many years of experience in the clinical use of mepivacaine, indications and clinical recommendations for its use have been developed. Of course, mepivacaine is not an “every day” anesthetic; however, there are a number of clinical cases when its use is most appropriate.

Patients with chronic general somatic diseases.

First of all, the use of mepivacaine is most justified in patients with cardiovascular pathology and restrictions on the use of a vasoconstrictor. If a low-traumatic intervention lasting less than 20-25 minutes is planned, there are indications for the use of 3% mepivacaine, which does not affect the patient’s hemodynamic parameters (BP, HR). If longer-term treatment or intervention is planned in the area of ​​the mandibular molars, from a clinical point of view, the use of only articaine-containing anesthetics with a vasoconstrictor of 1:200,000 is justified.

Patients with a history of allergies.

There is a group of patients with bronchial asthma in whom the use of articaine with a vasoconstrictor is contraindicated due to the risk of developing status asthmaticus due to the preservatives contained in the carpule. Mepivacaine does not contain preservatives (sodium bisulfite), so it can be used for short-term interventions in this group of patients. For longer interventions in this group of patients, it is advisable to carry out dental treatment in specialized institutions under the guidance of an anesthesiologist. Mepivacaine can be used in patients with multivalent allergies and those allergic to a known anesthetic. Outpatient dental treatment for such patients is carried out after the conclusion of an allergist on the tolerability of the drug. According to the clinical experience of the authors of this article, the frequency of positive allergy tests for 3% mepivacaine is significantly lower in comparison with other carpulal anesthetics.

In therapeutic dentistry

mepivacaine is used in the treatment of uncomplicated caries: enamel caries, dentin caries. It is important to consider that the required duration of anesthesia is limited to the stage of preparation of hard dental tissues. After covering the formed cavity with adhesive material, further restoration will be painless. Accordingly, any planned invasive treatment should not exceed 15 minutes after the onset of anesthesia. Also, when planning treatment, one should take into account the low effectiveness of mepivacaine in anesthesia of canines and molars of the lower jaw with infiltration anesthesia and with intraligamentary anesthesia of the teeth of the lower jaw.

In surgical dentistry

mepivacaine is used for short-term surgical interventions. The greatest effectiveness was found when removing teeth with chronic periodontitis and when removing intact teeth for orthodontic indications. The role of mepivacaine in pain relief during surgical dressings is important. Often, the procedure for removing sutures, changing the wound covering in the tooth socket, and changing the iodoform dressing is painful for patients. The use of long-acting anesthetics is unjustified due to the subsequent long-term numbness of soft tissues, which can lead to self-injury of the surgical site when eating. In these cases, infiltration anesthesia is used in a volume of 0.2-0.4 ml of 3% mepivacaine, and for dressings after extensive surgical interventions (cystectomy, excision of soft tissue formations, removal of an impacted third molar), conduction anesthesia is performed. The use of mepivacaine during outpatient surgical dressings can reduce patient discomfort and stress.

Pediatric dentistry.

Short-acting anesthetics have proven themselves well when used in pediatric dentistry. When using mepivacaine, the dosage of this drug should be taken into account when performing local anesthesia in children. Mepivacaine is more toxic to the central nervous system than articaine because it is rapidly absorbed into the bloodstream. Also, the clearance of mepivacaine is higher than the clearance of articaine for several hours. The maximum dosage of 3% mepivacaine is 4 mg/kg of body weight for a child over 4 years of age (Table No. 2). However, in pediatric dentistry there are no indications for the use of such high volumes of anesthetic. According to modern safety standards, the dosage of 3% mepivacaine administered should not exceed half the maximum dose for the entire dental treatment. With this use, cases of local anesthetic overdose (weakness, drowsiness, headaches) in pediatric practice are excluded.

When using mepivacaine, cases of self-injury of the soft tissues of the oral cavity by a child after treatment at the dentist are practically excluded. According to statistics, up to 25-35% of preschool children injure the lower lip after treatment of the lower teeth, and in most cases this is associated with the use of long-acting anesthetics based on articaine with a vasoconstrictor. Short-acting local anesthetics can be used when sealing dental fissures, treating initial forms of caries, and removing temporary teeth. The use of mepivacaine in children with polyvalent allergies and bronchial asthma is especially justified, since the drug does not contain preservatives (EDTA, sodium bisulfite).

Pregnancy and breastfeeding.

Mepivacaine can be safely used in pregnant women during routine sanitation of the oral cavity at the dentist according to the indications described above. In most cases, 3% mepivacaine is used for short-term and minimally invasive interventions lasting up to 20 minutes. The second trimester of pregnancy is most favorable for treatment.

Mepivacaine can be used in breastfeeding women; it is found in mother's breast milk in concentrations that are insignificant for the child. However, the patient is recommended to refrain from feeding the child for 10-12 hours after anesthesia with 3% mepivacaine and for 2 hours after anesthesia with 4% articaine with epinephrine, which completely eliminates the effect of the anesthetic on the child.

conclusions

Thus, mepivacaine-containing anesthetics (Mepivastezin) have found their use in various fields of dentistry. For a certain group of patients, these anesthetics are the only drugs for local anesthesia due to general somatic features. As a short-acting anesthetic, the drug can be well used for minimally invasive short-term interventions.

Table No. 1. Features of the clinical use of 3% mepivacaine (Mepivastezin)

Table No. 2. Dosage of 3% mepivacaine based on patient weight (adult/child)

Guidance and Warnings

To carry out infiltration or conduction anesthesia, a cartridge syringe with a standard carpule (reservoir with solution) with a rubber piston.

Before use, the medicinal product should be visually assessed for the presence of flakes, sediment, foreign particles, discoloration, and damage to the container. If the cartridge has defects, it should not be used.

Before starting anesthesia, the rubber stopper is treated with an antiseptic (alcohol); the bottle should not be placed in a disinfectant solution. The anesthetic is not mixed with any other drug.

To avoid puncture of the vessel, you need to carefully perform an aspiration test in several planes (rotating the needle 180°). But this does not exclude unintentional or undetected intravascular puncture.

Accidentally puncturing a nerve will cause the medication to spread throughout the nerve. If the patient experiences sharp pain or a sensation of electric shock during the injection, the needle should be slightly removed. This will help avoid damage to nerve fibers.

The rate of administration of Scandonest should not exceed 0.5 ml in 15 seconds; a full cartridge is administered within a minute.

In most cases, negative systemic reactions when entering a vessel or nerve can be avoided thanks to the correct injection technique. After aspiration, slowly inject 0.1-0.2 ml of solution, then slowly inject the remainder - no earlier than after 20-30 seconds.

Important! Capsules with any remaining unused anesthetic must be disposed of. It is prohibited to use them on other patients.

Causes of development of radiation caries and tactics of its treatment.

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Side effects

Any medicinal substance can cause negative effects of varying severity. In the case of using Scandonest, these may be reactions of different body systems.

CNS:

• drowsiness and lethargy;
• motor impairment;
• failure of tactile sensations;
• dizziness, headache;
• excessive excitability, anxiety;
• trembling of limbs;
• dilated pupils;
• loss of consciousness.

Vascular system:

• arrhythmia, tachycardia;
• decrease in pressure;
• bradycardia;
• pain in the sternum.

The patient may experience nausea and vomiting, fecal and urinary incontinence, and respiratory depression. In some cases, allergy symptoms may occur - hives, itching, rashes, swelling at the injection site. Numbness and a cold feeling at the injection site (as well as the lips and tongue) are common symptoms. Severe side effects include the patient's state of shock.

Important! The appearance of side effects requires qualified medical care.

Scandonest slows down motor reactions, so after use it is not recommended to drive a vehicle or work with equipment that requires concentration and precise movements.

Precautions

To avoid allergic reactions, it is recommended to do a test test by injecting a small volume of the drug - 5%.

Patients should not eat or chew gum until tissue sensation is fully restored. There is a certain risk of biting your lip, cheek or tongue.

Drug interactions

When using Scandonest and Cimetidine (a drug used to treat peptic ulcers), the level of anesthetic in the blood increases. An anesthetic in combination with drugs for hypertension, arrhythmia, and myocardial infarction accelerates the contraction of the heart muscle.

Sedatives that depress the central nervous system require a reduction in the dose of pain medication, since Scandonest also depresses the central nervous system.

In patients taking anticoagulants (blood thinners), the risk of bleeding, including internal bleeding, increases.

With the simultaneous use of narcotic analgesics and general anesthesia (ether, chloroform), toxic synergism may develop.

Release form and price

Scandonest is available in transparent glass cartridges of 1.8 ml. At one end, the carpules are sealed with a rubber stopper and an aluminum cap, at the other - with a rubber piston plug.

Analogs

An absolute analogue based on mepivacaine is Sandinibsa (manufacturer – Spain). The effect of the substance begins in 2-3 minutes and lasts 45 minutes.

It does not have a vasoconstrictor effect, so it can be used in patients with chronic diseases of the cardiovascular system.

Mepivastezin – based on mepavacaine (manufacturer – Palestine). The anesthetic can be used in children weighing less than 20 kg, and the maximum dosage should not exceed 1.8 ml.

Artifrine is a solution based on articaine and epinephrine (a vasoconstrictor). It should not be administered to people with diseases of the hematopoietic system, ventricular tachycardia, hypoxia, and angle-closure glaucoma.

Which anesthetic should I choose?

• For bronchial asthma or high allergies, it is best to choose an anesthetic without preservatives, for example Ultracaine D.
• For thyroid diseases and diabetes mellitus, you should use anesthetics that do not contain vasoconstrictor components - Ultracain D or Scandonest.
• For high blood pressure and heart disease, anesthetics with an epinephrine concentration of 1:200,000 are chosen - Ultracain DS, Ubistezin. For decompensated heart diseases and severe hypertension, anesthetics that do not contain epinephrine and adrenaline should be used - Ultracaine D.
• In the absence of the above diseases, you can use anesthetics with an epinephrine concentration of 1:100,000 - Ultracain DS forte, Ubistezin forte.
• During pregnancy and breastfeeding, anesthetics with an epinephrine concentration of 1:200,000 are chosen - Ultracain DS, Ubistezin. This concentration does not affect the fetus and is not detected in breast milk.

Reviews

On the forums you can find different opinions about the effectiveness of Scandonest. If you have had experience with dental treatment using the drug, share your impressions, tell us how comfortable the manipulations were, how quickly you recovered from anesthesia.

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