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.