BACKGROUND: The maximum recommened dose for lidocaine and mepivacaine with epinephrine is about 500 mg regardless of the injection site. But this dose is insufficient for brachial plexus block and it is known that mepivacaine is safer than lidocaine. So the purpose of this study was to determine whether the serum concentrations of 1.5% lidocaine 600 mg with epinephrine and 1.5% mepivacaine 600 mg with epinephrine are within a safe range and to know any differences between them during axillary brachial plexus block. METHODS: Fifteen ASA physical status class I-II patients were selected. They were randomly divided into two groups. Group L patients (n=8) were anesthetized with 40 ml 1.5% lidocaine (600 mg) with epinephrine and group M patients (n=7) with 40 ml 1.5% mepivacaine (600 mg) with epinephrine. The serum concentrations were measured at the 5, 15 and 30 minutes after injection. RESULTS: The serum concentrations were 1.99 +/- 1.47, 2.66 +/- 1.03 and 2.41 +/- 1.41 microgram/ml in group L, and 3.03 +/- 0.64, 4.07 +/- 0.93 and 3.99 +/- 1.02 microgram/ml in group M at the 5, 15 and 30 minutes after injection. There were no symptoms or signs of local anesthetic toxicity, and serum levels of lidocaine and mepivacaine remained below the level that usually caused toxic symptoms. CONCLUSIONS: Although the serum concentration of mepivacaine group was higher than that of lidocaine group at each time, 1.5% lidocaine 600 mg with epinephrine and 1.5% mepivacaine 600 mg with epinephrine can be safely administered into the axillary sheath because the serum concentrations are within a safe range.
Brachial Plexus* ; Epinephrine ; Humans ; Lidocaine* ; Mepivacaine*

BACKGROUND: Recently, ultrasound guidance in clinical procedures including brachial plexus block has gained popularity. This method has been considered to be an efficient and a useful method with real-time visualization. Many reports have showed the usefulness of ultrasound-guided brachial plexus block. We evaluated the usefulness of ultrasound guidance in infraclavicular brachial plexus block compared with nerve stimulation. METHODS: Thirty patients were randomized into two groups of US group (ultrasound-guided block) and NS group (nerve stimulation). Blocks were performed with mepivacaine 2% and bupivacaine 0.5% with epinephrine 1:200,000 (total volume 40 ml). Block execution time, onset time, success rate, patient's discomfort and complications were measured and statistically evaluated for the comparison. RESULTS: Block execution time were 88.3 +/- 48.1 sec in US group and 172.7 +/- 103.1 sec in group NS, respectively (P = 0.017). Onset time were 16.0 +/- 6.9 min and 17.7 +/- 7.8 min (P = 0.434). Success rates were 93.3% and 80.0% (P = 0.283). Patient's discomfort was not significantly different. Pain in patients with fractured arm was significantly lower in US group (P = 0.004). CONCLUSIONS: An ultrasound-guided infraclavicular brachial plexus block is useful with less time consumption and less discomfort in patients with fracture of arm. Success rate and onset time were acceptable.
Arm ; Brachial Plexus ; Bupivacaine ; Epinephrine ; Humans ; Mepivacaine

BACKGROUND: The effect of the unilateral stellate ganglion block (SGB) on cardiovascular regulation remains controversial. We wished to evaluate the changes in heart rate variability (HRV) after a unilateral stellate ganglion block in patients with head and neck pain in the present study. METHODS: Patients with head and neck pain (n = 89) were studied. HRV was determined before and after a C6 unilateral stellate ganglion block (right-sided SGB, 40; left-sided SGB, 49) using a paratracheal technique with 1% mepivacaine (6 ml). RESULTS: There were no significant differences in HRV indices before and after right-sided SGB. The log scale of power in the high frequency range (lnHF) was increased and ratio of power in the low frequency range (LF) to power in the high frequency range (HF) ratio was decreased after left-sided SGB. CONCLUSIONS: These results demonstrated that left-sided SGB increased parasympathetic activities in patients with head and neck pain.
Head ; Heart ; Heart Rate ; Humans ; Mepivacaine ; Neck Pain ; Stellate Ganglion

Since the early 1980s, the implantable intrathecal drug pump (ITDP) has been used increasingly to manage chronic pain. Prior to making a decision to implant an ITDP, trial administration of the intrathecal (IT) drug should be performed to estimate the effective dose for a starting set of implantable ITDPs. There is no standard method of trial IT drug administration, though. Therefore, this paper reports 20 cases of IT morphine trial with single and repetitive injections until the appropriate dose was attained with respect to analgesia and its side effects. The trial procedure was performed with daily sequential IT injections using morphine and 0.3% mepivacaine. Twelve out of the total of 20 patients had positive responses. Thus, it is inferred that daily sequential IT morphine injections combined with a placebo injection as a trial ITDP would be useful in evaluating the effectiveness and adverse effects of IT morphine infusion with clinically insignificant side effects.
Analgesia ; Chronic Pain ; Humans ; Mepivacaine ; Morphine ; Pain, Intractable

BACKGROUND: The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. METHODS: One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. RESULTS: The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 +/- 6.9 min, 13.6 +/- 4.5 min, 16.7 +/- 4.6 min, and 16.5 +/- 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). CONCLUSIONS: In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.
Anesthetics, Local ; Horner Syndrome ; Humans ; Mepivacaine ; Nerve Block

BACKGROUND: Although an ultrasound-guided brachial plexus block has become the standard, conventional brachial plexus blocks with a paresthesia or muscle twitch are still performed. However despite eliciting a paresthesia or muscle twitch, there are some cases in whom the brachial plexus block fails. This has been attributed to the difference between the proximal response (PR) and distal response (DR). Therefore, this study compared a supraclavicular block showing a PR with that showing a DR. In addition, clinical data such as success rate, onset time, and complications were examined. METHODS: Eighty three patients received a supraclavicular block with a nerve stimulator. All blocks were performed with 1% mepivacaine 40 ml. The subjects were divided into two groups-Group PR (n = 20, contraction of triceps or biceps) and Group DR (n = 63, flexion or extension of wrist or fingers) according to the types of muscle twitch. The success rate, onset time, and complications were measured and evaluated. RESULTS: The success rate of Group DR (93.7%) was higher than that of Group PR (75.0%) (P < 0.05). The onset times of Group PR and DR were 15.3 +/- 6.7 min and 14.4 +/- 6.0 min, respectively. CONCLUSIONS: The elicitation of a DR was more effective in increasing the success rate and reducing the onset time than the elicitation of a PR in a single-injection supraclavicular block.
Arm ; Brachial Plexus ; Contracts ; Fingers ; Humans ; Mepivacaine ; Muscles ; Paresthesia ; Wrist

BACKGROUND: This study describes the authors' experience with patients who received an epidural steroid injection (ESI) for lumbosciatica with radicular leg pain as predominant symptom. We analyzed the efficacy of ESI according to duration of pain and history of prior lumbar spine surgery. METHODS: One hundred thirty-six patients who had low back pain with radicular symptoms were included. Each patient was given 10 ml of 1% mepivacaine mixed with 40 mg of methylprednisolone every two weeks until at least a 75% improvement or reduction in pain was seen. We recommended no more than 3 injections within 3 months. RESULTS: Three to six months after the first injection the more favorable results were observed in patients with subacute radicular leg pain (less than 3 months' duration)(87.6 - 75%, good-excellent) and chronic leg pain with no prior surgery (greater than 3 months' duration)(84.8 - 71%, good-excellent) than in patients with chronic leg pain with prior surgery (50 - 40.1%, good-excellent). The efficacy of ESI was decreased after 1 year after the first ESI. CONCLUSIONS: ESI was effective in the management of lumbosacral radicular pain regardless of duration of symptoms. However, patient's who had had prior lumbar spine surgery had the least satisfactory results.
Humans ; Leg ; Low Back Pain* ; Mepivacaine ; Methylprednisolone ; Spine

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Anesthesia, General ; Brachial Plexus ; Forearm ; Hand ; Humans ; Mepivacaine ; Needles

BACKGROUND: Multiple needle attempts to gain a muscle twitch or a paresthesia for a classical supraclavicular brachial plexus block can increase the risks of nerve damage or pain. The aims of this study were to obtain reliable clinical data on ultrasound-guided supraclavicular blocks, demonstrate the higher success rate and fewer complications, and design an injection method for patients whose brachial plexus can not be located. METHODS: 105 patients received an ultrasound-guided supraclavicular block. 40 ml of 1% mepivacaine was injected without a muscle twitch or paresthesia. The groups were divided into two groups - Group A (n = 92, patients who had visible brachial plexus) and Group B (n = 13, patients whose brachial plexus can't be located). After the blocks, the clinical characteristics such as the success rate, the time to onset, the extent of the sensory block, and occurrence of complications were evaluated. RESULTS: The Success rate of Group A (98.9%) was higher than that of Group B (84.6%) (P < 0.05). The overall success rate was 97.1%. All patients could be operated on under sedation. The time to onset of Group A (12.6 +/- 4.4 min) was shorter than that in Group B (23.1 +/- 5.1 min) (P < 0.05). The overall time to onset was 13.8 +/- 5.5 min. There were no serious complications such as pneumothorax. CONCLUSIONS: An ultrasound-guided supraclavicular block is very effective in even patients whose brachial plexus can not be located.
Brachial Plexus ; Humans ; Mepivacaine ; Muscles ; Needles ; Paresthesia ; Pneumothorax

BACKGROUND: The use of caudal morphine for postoperative analgesia has been increased in popularity since 1981. The purpose of this study was to compare the effect of analgesia and incidence of side effects of a mepivacaine-morphine mixture with mepivacaine alone. METHODS: Forty patients were randomly divided into two groups. In group 1, caudal block was performed with 1% mepivacaine 1 ml/kg alone. In group 2, caudal block was performed with 1% mepivacaine 1ml/kg-morphine 0.03 mg/kg mixture. Postoperative five-point pain scores and side effects were measured. RESULTS: There were no significant differences in sedation dose, incidence of side effects and supplemental analgesics. Pain scores were significantly lower at postoperative 2 and 3 hours in mepivacaine-morphine mixture group. CONCLUSIONS: Caudal epidural mepivacaine-morphine (0.03 mg/kg) mixture is effective in children for control of postoperative pain without significant side effects.
Analgesia* ; Analgesics ; Child* ; Humans ; Incidence ; Mepivacaine ; Morphine* ; Pain, Postoperative