Eurasian Journal of Biosciences

Unaddressed local anesthesia reversal action of phentolamine mesylate after plain mepivacaine


Background and Aim: Clinical studies concerning the effect of intraoral injection of phentolamine mesylate on the duration of soft tissue anesthesia and its related functional deficits after using a plain local anesthetic are scarce. This study is to evaluate the efficacy and safety of phentolamine mesylate as a local anesthesia reversal agent after plain mepivacaine using mental/incisive nerve block.
Methods: Twenty patients who received plain mepivacaine as a local anesthetic were randomly assigned into two groups: group I (sham injection group) and group II (phentolamine mesylate group). Sham injection or phentolamine mesylate injection was given 30 minutes after mepivavaine injection. Time to return to normal soft tissue sensation and normal oral functions was recorded to assess efficacy of phentolamine mesylate. Intraoral assessment, monitoring hemodynamic vital signs and presence of any drug-related adverse effects were used to assess safety of phentolamine mesylate.
Results: there were statistically significant differences (p< 0.001) in the mean duration to recovery of normal sensation in the lower lip, chin and gums between group I and group II. Also there were statistically significant differences (P<0.001) in the mean duration to perceive normal sensation and in the mean duration to demonstrate normal oral functions between the two groups. No statistically significant differences were observed in hemodynamic vital signs between periods of measurements in each group nor between the two groups. No changes were observed on intraoral examination and no drug related adverse events occurred. All patients were satisfied with the rapid recovery of normal sensation and oral functions.
Conclusion: Phentolamine mesylate is efficient and safe for rapid recovery of normal sensation and oral functions after using plain mepivacaine


  • Babaei M, Nourbakhsh N, and Shirani F (2012) Effect of phentolamine mesylate on duration of soft tissue local anesthesia anesthesia in children’, Journal of Research in Pharmacy Practi,” J. Res. Pharm. Pract., 2012.
  • Bortoluzzi M C, de Camargo P, Smolarek R, Cecato M, Pochapski T and Chibinski A C (2018) Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial,” Int. J. Oral Maxillofac. Surg., vol. 47, no. 7, pp. 933–939.
  • Boynes S G, Riley A E, Milbee S, Bastin M R, Price M E, and Ladson A (2013) Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic.,” Gen. Dent., vol. 61, no. 5, pp. 70–76.
  • Daubländer M, Liebaug F, Niedeggen G, Theobald K, and Kürzinger M L (2017) Effectiveness and safety of phentolamine mesylate in routine dental care,” J. Am. Dent. Assoc., vol. 148, no. 3, pp. 149–156.
  • Devadiga S, Shetty D, and Hittalmani S (2019) Phentolamine Mesylate: An Antidote for Local Anesthesia; A Boon in Dentistry,” Res. Rev. A J. Dent., vol. 5, no. 1, pp. 11–14.
  • Eldor J and Nguyen T A (2018) Lipid Emulsion for Local Anesthesia Reversal (LAR) after Prolonged Spinal/Epidural Anesthesia,” Jor Heal. Sci Dev., vol. 1, no. 1, pp. 43–47.
  • Fowler S M (2010) A prospective, randomized single-blind study to evaluate the reversal of soft tissue anesthesia in endodontic patients.” The Ohio State University, 2010.
  • Fowler S, Nusstein J, Drum M, Reader A, and Beck A (2011) Reversal of soft-tissue anesthesia in asymptomatic endodontic patients: a preliminary, prospective, randomized, single-blind study, J. Endod., vol. 37, no. 10, pp. 1353–1358.
  • Goswami A, Bora B, Kundu G K, and Ghosh S (2014) Reversal of residual soft-tissue anesthesia: A review,” Int J Sci Stud, vol. 2, no. 3, pp. 86–89.
  • Grover H S, Gupta A, Saksena N, and Saini N (2015) Phentolamine mesylate: It’s role as a reversal agent for unwarranted prolonged local analgesia,” J. Indian Soc. Pedod. Prev. Dent., vol. 33, no. 4, p. 265.
  • Heft M W and Parker S P (1984) An experimental basis for revising the graphic rating scale for pain,” Pain, vol. 19, no. 2, pp. 153–161.
  • Helmi M, AlDosari M, and Tavares M (2018) Phentolamine mesylate may be a safe and effective option to reduce discomfort and time to recovery after dental care with local anesthesia, J. Evid. Based Dent. Pract., vol. 18, no. 2, pp. 181–184.
  • Hersh E V et al. (2008) Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults,” J. Am. Dent. Assoc., vol. 139, no. 8, pp. 1080–1093.
  • Hersh E V et al. 92017) Phase four, randomized, double-blinded, controlled trial of phentolamine mesylate in two-to five-year-old dental patients,” Pediatr. Dent., vol. 39, no. 1, pp. 39–45.
  • Hersh E V and Lindemeyer R G (2010) Phentolamine mesylate for accelerating recovery from lip and tongue anesthesia,” Dent. Clin., vol. 54, no. 4, pp. 631–642.
  • Hersh E V, Hermann D G, Lamp C J, Johnson P D, And Macafee K A, (1995) Assessing the duration of mandibular soft tissue anesthesia,” J. Am. Dent. Assoc., vol. 126, no. 11, pp. 1531–1536.
  • Katagiri K, Hashimoto S, and Sunda K (2020) Effect of vasopressin as a local anesthetic in mice, Odontology, pp. 1–10.
  • Koss DM C (2002) ifferential neural activation of vascular α-adrenoceptors in oral tissues of cats, Eur. J. Pharmacol., vol. 440, no. 1, pp. 53–59.
  • Laviola M et al., (2008) Randomized study of phentolamine mesylate for reversal of local anesthesia,” J. Dent. Res., vol. 87, no. 7, pp. 635–639.
  • Malamed S F (2019) Handbook of local anesthesia-e-book. Elsevier Health Sciences.
  • McDonald E R, Avery D R, Dean J A, and Jones J (2016) Local anesthesia and pain control for the child and adolescent,” in McDonald and Avery Dentistry for the Child and Adolescent, Elsevier Inc., 274–285.
  • Michaud L P, Flood B, and Brillant M S (2018) Reversing the effects of 2% Lidocaine: A randomized controlled clinical trial,” J. Dent., vol. 72, pp. 76–79.
  • Moore P A et al (2008) Pharmacokinetics of lidocaine with epinephrine following local anesthesia reversal with phentolamine mesylate.,” Anesth. Prog., vol. 55, no. 2, pp. 40–48.
  • Saunders T R, Psaltis G, Weston J F, Yanase R R, Rogy S S, and Ghalie R G (2011) In-practice evaluation of OraVerse for the reversal of soft-tissue anesthesia after dental procedures.,” Compend. Contin. Educ. Dent. (Jamesburg, NJ 1995), vol. 32, no. 5, pp. 58–62.
  • Silvera A M (2013) Does phentolamine mesylate reverse soft-tissue anesthesia after 3% mepivacaine?” UCLA.
  • Sirintawat N, Sawang K, Chaiyasamut T, and Wongsirichat T (2017) Pain measurement in oral and maxillofacial surgery,” J. Dent. Anesth. pain Med., vol. 17, no. 4, pp. 253–263.
  • Srikar M V, Aravind A, Niranjan B N, Khandeparker R V, and Grover S (2015) Phentolamine Mesylate in Reversal Local Anesthesia: A Review,” J. Int. Oral Heal., vol. 7, no. 11, p. 129.
  • Tavares T et al. (2008) Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients,” J. Am. Dent. Assoc., vol. 139, no. 8, pp. 1095–1104.
  • Vintanel Moreno C B (2019) Influencia en la satisfacción de los pacientes tras la administración de OraVerse® en tratamientos implantológicos.” Universidad Complutense de Madrid, 2019.
  • Yagiela J A (2011) What’s new with phentolamine mesylate: a reversal agent for local anaesthesia?,” SAAD Dig., vol. 27, pp. 3–7.


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