RESEARCH MONOGRAPH · KDC-MN-1312
Mepivacaine
Mepivacaine (Carbocaine, Polocaine) is the methyl-substituted parent of the pipecoloxylidide family that includes bupivacaine and ropivacaine. Introduced in the late 1950s by Bo af Ekenstam at AB Bofors. The methyl substituent on the piperidine nitrogen makes mepivacaine the shortest-acting member of its family, with onset in 3 to 5 minutes and duration of 2 to 3 hours. Two niches in current practice: dental anesthesia (the 3 percent plain solution avoids epinephrine when the vasoconstrictor is contraindicated, and the duration matches typical procedure length), and ambulatory orthopedic spinal anesthesia where shorter duration than bupivacaine permits earlier ambulation. Sold as a racemate. Cardiotoxicity is intermediate between lidocaine and bupivacaine. Lipid emulsion rescue applies as for any local anesthetic systemic toxicity event. Not stocked by Kodiac. This monograph is provided for research and educational reference.
Intrigue 0–100 blends mechanism novelty, evidence strength, and translational potential. Kodiac editorial, not peer-reviewed.
Amide local anesthetic (intermediate-acting)
The methyl-substituted pipecoloxylidide parent of bupivacaine and ropivacaine, used in dental and orthopedic regional anesthesia.
Abstract
Mepivacaine (1-methyl-N-(2,6-dimethylphenyl)piperidine-2-carboxamide; CAS 96-88-8; molecular formula C15H22N2O; molecular weight 246.35) is an amide local anesthetic synthesized by Bo af Ekenstam at AB Bofors in the same pipecoloxylidide series that produced bupivacaine and ropivacaine. The compound was introduced clinically in the late 1950s (Carbocaine, Polocaine) as a successor to lidocaine for dental and short-procedure regional anesthesia. The methyl substituent on the piperidine nitrogen makes mepivacaine the shortest-acting member of the pipecoloxylidide family; lipid solubility and protein binding are intermediate between lidocaine and bupivacaine. Mechanism is voltage-gated sodium channel block. Onset is 3 to 5 minutes for infiltration; duration is 2 to 3 hours, longer with epinephrine. The principal niches in current practice are dental anesthesia (the 3 percent plain solution avoids epinephrine in patients where the vasoconstrictor is contraindicated, and the intermediate duration matches typical dental procedure length), and ambulatory orthopedic spinal anesthesia where the shorter duration relative to bupivacaine permits earlier ambulation and discharge. Mepivacaine is sold as a racemate. Cardiotoxicity is intermediate between lidocaine and bupivacaine; lipid emulsion rescue applies to LAST. The ester-class procaine and chloroprocaine are alternative short-acting infiltration agents; mepivacaine retains a market niche owing to the absence of the para-aminobenzoic acid metabolite that drives ester allergic reactions.
Mechanism of action
Voltage-gated sodium channel block, state-dependent. Shorter alkyl chain than bupivacaine and ropivacaine drives shorter duration.
Reported research dose ranges
Reported research dose ranges vary across the published literature.
References
- Covino BG. Pharmacology of local anaesthetic agents. Br J Anaesth 1986.
- Hadzic A. Textbook of Regional Anesthesia and Acute Pain Management. 2007.
Read the full monograph
Available as a research-use-only PDF download.
The full reference document is provided strictly for research use only. It reports research dose ranges from the published literature, not instructions for use in humans or animals.
FOR RESEARCH USE ONLY. Not for medical, diagnostic, or therapeutic purposes. Not for human consumption. All information is provided for research and educational purposes only.