Q. Why dentists do not use Bupivacaine for nerve block?

Answered by
Dr. Nupur Prashant Shah
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 14, 2018 and last reviewed on: Sep 16, 2020

Hi doctor,

Is there a reason why dentists typically do not use Bupivacaine for nerve block for dental procedures? So far, only one dentist used it for me. While it had a slow onset, I was pain free for almost 8 hours. I did not need to take as many narcotic analgesics afterwards. I have really severe anxiety when it comes to dentistry due to dental trauma and painful procedures. Bupivacaine helped ease my anxiety about post procedure pain. I have asked every dentist I have seen to use Bupivacaine. But, they have always chosen Carbocaine. I also have a vasovagal response to epinephrine and Bupivicaine formulations have a lower ratio of epinephrine as compared to Mepivacaine and Lidocaine. I have always informed them of my response to epinephrine, but they still always chosen Carbocaine (Mepivacaine). Is there a pharmacological justification for not using it? Or is it just provider preference? Is there a way I can advocate for myself as a patient? I work in a pharmacy, so I am familiar with a lot of these medications. Thank you for your thoughts on this.



Welcome to

I have gone through your query and understand it.

  • As you are working in pharmacy, I would like to inform you that Bupivacaine is a long acting, local amide and local anesthetic agent.
  • It is a chemical analogue of Mepivacaine with high lipid solubility and protein binding characteristics. Its action starts within 2 to 5 minutes and remains longer for 6 to 8 hours.
  • In routine, dental procedures are usually not so long and there is no need to give such high quality of anesthetic agent to everyone. So, it is less used in dentistry.
  • If you want your procedures under Bupivacaine, then you can go to the dentist who uses Bupivacaine for your procedures.

For further information consult a dentist online -->

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