Effect of propranolol on mepivacaine serum concentrations in dental practice

ObjectiveThe objective of this study was to determine the effect of propranolol pretreatment on mepivacaine serum concentrations in dental patients.Study designIn a double blind, randomized, 2-way crossover study, 10 patients ingested 30 mg propranolol or placebo, 2 hours before local anesthesia for dental scaling. Each subject received a single dose of 51 mg mepivacaine for posterior superior alveolar nerve block. Mepivacaine in venous serum was measured for up to 1 hour, after 5, 15, 30, 45, and 60 minutes from injection. Serum concentrations of mepivacaine were determined by gas chromatography. Blood pressure and heart rate were measured before and after propranolol or placebo and after each sampling.ResultsPeak serum concentrations of mepivacaine, Cmax (1.214 ± 0.746 μg/mL−1), were significantly increased by propranolol (2.249 ± 1.559 μg/mL−1, P < .05). Propranolol pretreatment reduced blood pressure and heart rate.ConclusionAlthough propranolol pretreatment increased almost doublefold mepivacaine serum concentrations and reduced blood pressure and heart rate, mepivacaine can be used safely in dental patients taking propranolol for short-duration interventions.