Mepivacaine base

Picolinoxylidide is prepared by the condensation of picolinic acid (2-pyridinecarboxylic acid) with 2,6-xylidine which on methylation with dimethyl sulphate in xylene yields the corresponding N-methyl derivative. This when subjected to platinum-catalysed hydrogenation in active aeetie aeid followed by alkalinization yields mepivacaine base, which is then dissolved in an inert solvent and made to react with an equimolar amount of hydrochloric acid. 

The choice of local anesthetic for infiltration, peripheral nerve blocks, and central neuraxis (spinal/epidural) blockade is usually based on the duration of action required. Procaine and chloroprocaine are short-acting lidocaine, mepivacaine, and prilocaine have an intermediate duration of action and tetracaine, bupivacaine, levobupivacaine, and ropivacaine are long-... 

These local anesthetics, including lidocaine (Xylocaine), mepivacaine (Carbo-caine), Prilocaine (Citanest), and bupivacaine (Marcaine) are weak sensitizers, but allergic reactions are sporadically reported, e. g., lidocaine (Turner 1977). Recently Fregert et al. (1979) described two patients developing lidocaine allergy after 8 and 1 month use of Xyloproct ointment (lidocaine 5%, hydrocortisone acetate) they also had positive patch tests to related amide anesthetics, both to mepivacaine, one to bupivacaine and prilocaine. A positive reaction to the chemically unrelated cincaine was interpreted as concomitant sensitivity rather than cross-sensitivity. Safe substitutes for benzocaine-sensitive patients include lidocaine, mepivacaine, prilocaine, bupivacaine, and pyrocaine (Fisher 1973 p. 312), all based on an amide structure. Lidocaine-sensitive patients may use tetracaine (pontocaine), a derivative of aminobenzoic acid. 

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