Why dentists do not use Bupivacaine for nerve block?

Question

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 afterward. I have 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 Bupivacaine 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 chose 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.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand it. I would like to inform you that Bupivacaine is a long-acting, local amide, and local anesthetic agent It is a chemical analog 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 agents 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.

I hope this helps.

Thank you.