A Clinician’s Guide to Clinical Endodontics
Intraosseous Block

Although the literature supports the use of an anesthetic with vasoconstrictor for administering for an intraosseous block,²⁵ the clinician needs to be aware that this will increase heart rate in most patients.²⁶ Therefore, the clinician needs to balance a longer anesthetic effect along with a patient’s tachycardia response versus using 3% mepivacaine (with no epinephrine) and eliminating the cardiac effect but shortening the duration of the local anesthetic effect. A study by Reisman et al²⁷ reported that when a repeated intraosseous injection with 3% mepivacaine (with no epinephrine) was administered, there was an increase in anesthetic success to 98%. Empirically, most patients get an uncomfortable feeling when their heart begins to race after the epinephrine enters their system as the result of the intraosseous block.