Why dentists do not use Bupivacaine for nerve block?

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: Aug 27, 2023

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 icliniq.com.

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 two to five 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.

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