Local Dental Anesthesia MCQs – Dental MCQs

Local Dental Anesthesia MCQs – Dental MCQs

1. The most rigid portion of a syringe is
a) hub
b) shaft
c) needle
d) handle

2. According of pain, large fiber impulses tend to:
a) by pass the central control process
b) inhibit the effect of painful stimuli transmitted by small fibers
c) transmit severe chronic pain only
d) potentiate the effect of painful stimuli

4. The primary site of action of the local anesthetic is on:
a) axoplasm
b) epineurium
c) nerve membrane
d) perineurium

6. Rapid onset of action seen by local anesthesia in small nerve endings is due to:
a) increased threshold of small nerves due to depolarization
b) low pH of small nerve fibres
c) high ratio of surface area to the volume of small nerve fibres
d) increased resting potential of small nerve fibres

7. To give field block the LA should be deposited near:
a) main trunk
b) large branch of peripheral nerve
c) small nerve endings
d) periodontal ligament

8. A contraindication to local infiltration technique:
a) Hypertension
b) Diabetic patient with presence of urine sugar
c) Infection in the arch
d) Kidney problems

9. For extraction of mandibular molar, anesthesia is given to act on:
a) inferior alveolar nerve
b) buccal nerve
c) infraorbital nerve
d) masseteric nerve

10. During inferior alveolar nerve block the LA solution is deposited into which space:
a) Infratemporal space
b) Sub maxillary space
c) Pterygo mandibular space
d) Massetric space

11. In case of Gow-Gates technique the target area is
a) Neck of condyle
b) Head of the condyle
c) Medial side of the ramus
d) Lateral side of the condyle

12. In Vazirani-Akinosis mandibular block which is not a last mark:
a) Mucogingival fold in relation of maxillary third molar
b) Maxillary tuberosity
c) Soft tissue medial ramus
d) Coronoid notch

13. High tuberosity technique is a technique used to anesthetize:
a) maxillary nerve
b) posterior superior alveolar nerve
c) mandibular nerve
d) trigeminal nerve trunk

14. For extraoral maxillary nerve block the target area is
a) anterior to lateral pterygoid plate
b) posterior to lateral pterygoid plate
c) pterygomandibular fossa
d) pterygomandibular fissure

15. Mental foramen opening is directed:
a) forward and medial direction
b) backward and medial direction
c) forward and lateral direction
d) backward and lateral direction

16. Mucous membrane on the buccal aspect of the upper alveolar process is innervated by buccal nerve and?
a) superior alveolar nerve
b) mental nerve
c) interior alveolar nerve
d) greater palatine nerve

17. Anterior palatine nerve is anesthetized by anterior palatine nerve block. The subjective symptoms include:
a) feeling of numbness in the posterior palate
b) feeling of numbness in the anterior part of the palate near the incisors
c) feeling of numbness of whole palate
d) little or no subjective symptoms

18. Greater palatine foramen is situated:
a) between first and second maxillary molars
b) between second and third maxillary molars
c) between two central incisors
d) between first and second maxillary premolars

19. The following deep bony landmark is important in performing a block of the II and III divisions of the trigeminal nerve from the lateral approach:
a) Temporal surface of sphenoid
b) Perpendicular plate of the palatine bone
c) Lateral plate of the pterygoid
d) Styloid process

20. After the posterior superior nerve block patient should experience:
a) numbness of the lip
b) numbness of the palate till the first premolar
c) few symptoms of anesthesia
d) numbness of that side of face

21. The sudden appearance of a “Dumb-bell” swelling after the administration of PSA block is due to penetration in:
a) Maxillary artery
b) Pterygoid plexus of veins
c) reater palatine artery
d) Sphenopalatine artery

22. A surgical procedure required bilateral block. A bilateral inferior alveolar nerve block is
a) not contraindicated
b) should rarely be performed
c) may cause space infection
d) dangerous because patient may swallow the tongue

23. The following mandibular teeth can be removed without pain after the inferior alveolar and lingual nerve block:
a) All molars and second premolars
b) First molar and premolars
c) Canine and first premolar
d) All teeth in that quadrant

24. In the initial stage of paralysis of facial nerve
a) Tongue deviate to the same side on protrusion
b) Tongue deviate to the opposte side on protrusion
c) No deviation of the tongue
d) None of the above

25. Which of the following is true regarding local anesthesia?
a) They are basic salts of weak acids
b) Not effective in alkaline pH
c) Form salts with acids
d) They are acidic salts of weak bases

26. It is difficult to obtain local infiltration anesthesia in the presence of inflammation/infection because of:
a) a decreased PH
b) increased vascularity
c) oedema
d) pain

27. Alkalization of LA:
a) decreases the onset of action
b) speeds the onset of action
c) increases the efficiency of LA
d) Both B and C

28. Lidocaine is an example of an:
a) Acid
b) Amide
c) Ester
d) Aldehyde

29. A patient is allergic to PABA. Most probably he will also be allergic to:
a) lignocaine
b) carbocaine
c) prilocaine
d) tetracaine

30. The activity of procaine is terminated by:
a) elimination by kidney
b) storage in the adipose tissue
c) metabolism in the liver only
d) metabolism in the liver and by pseudocholinesterase in the plasma

31. The longest acting, most potent and most toxic L.A. is:
a) lidocaine
b) dibucaine
c) bupivacaine
d) tetracaine

32. Sodium bisulphate used in dental local anesthetic acts as:
a) antibacterial for lignocaine
b) antibacterial for adrenaline
c) antioxidant for methylparaben
d) antioxidant for adrenaline

33. Xylocaine strength used in dentistry is:
a) 2%
b) 5%
c) 8%
d) 10%

34. Alpha adrenergic agonists are used in combination with local anesthetics to:
a) increase the rate of liver metabolism of local anesthetic
b) increase the concentration of L.A. at receptor site
c) stimulate myocardial contraction
d) increases vascular absorption of L.A

35. Adrenaline is not added to which cases with local anesthetics:
a) Spinal anesthesia
b) Infiltration anesthesia
c) Surface anesthesia
d) Ring block

36. Among the following items in the past medical history, which would most affect the choice of local anesthetic agent?
a) RHD
b) Hyperthyroidism
c) Adrenal insufficiency
d) Asthma

37. The onset of action of lidecaine is:
a) 1-2 minutes
b) 5-10 minutes
c) 3-5 minutes
d) 7-8 minutes

38. Which of the following local anesthetic is a vasoconstrictor:
a) Lidocaine
b) Procaine
c) Bupivacaine
d) Ropivacaine

39. Which of the following is not used as a topical LA?
a) Procaine
b) Tetracaine
c) Lidocaine
d) Benzocaine

40. Maximum available and effective con-centration of LA for topical use is:
a) 2%
b) 5%
c) 10%
d) 15%

41. Longest acting local anesthesia is:
a) Bupivacaine
b) Tetracaine
c) Lidocaine
d) Procaine

42. Pka of lignocaine is:
a) 7.2
b) 7.4
c) 7.6
d) 7.9

43. The following is least toxic of all local anesthetics:
a) Tetracaine
b) Mepivacaine
c) Prilocaine
d) Chloroprocaine

44. Carticaine is the other name for:
a) Articaine
b) Mepivacaine
c) Procaine
d) Lidocaine

45. Maximum recommended dosage of lignocaine with 1:1,00,000 adrenaline subcutaneously is:
a) 100 mg
b) 30 mg
c) 500 mg
d) 700 mg

46. The maximum dose of lignocaine without adrenaline that can be admitted to a patient is
a) 4 mg/kg body wt
b)5 mg/kg body wt
c) 7 mg/kg body wt
d) 9 mg/kg body wt

47. How many mg of 2% lidocaine present in the cartidge?
a) 36 mg
b) 18 mg
c) 180 mg
d) 360 mg

48. How many mg of adrenaline is in each cartridge of 2% lignocaine with 1:1,00,000 adrenaline:
a) 0.36 mg
b) 0.036 mg
c) 0.018 mg d) 0.18 mg

49. How much lignocaine is present in 2.0 ml of 2% lignocaine solution?
a) 40 mg
b) 20 mg
c) 30 mg
d) 2 mg

50. Which of the following local anesthetic will be suitable for a hypertensive patient suffering from a heart disease?
a) Lignocaine without adrenaline
b) Prilocaine
c) Lignocaine with adrenaline 1:1000
d) Prilocaine and felypressin

51. Thirty seconds after the injection of 1.8 ml of local anesthetic containing 2% lidocaine with 1:1,00,000 adrenaline patient loses consciousness. The most probable diagnosis is:
a) Toxic reaction to the adrenaline
b) Cerebral hypoxia
c) Tachycardia
d) Toxic reaction to the lidocaine

52. Improper direction of the needle insertion during inferior alveolar nerve block results in
a) Facial nerve paralysis
b) Paraesthesia
c) Hematoma
d) Trismus

53. Increased incidence of reaction to L.A. will occur by:
a) rapid rate of injection
b) using an aspirating technique
c) addition of vaso constrictor to
d) premedication with barbiturate the solution

54. Local anesthetic causing methemoglobinemia:
a) Prilocaine
b) Etidocaine
c) Lignoacine
d) Bupivacaine

55. The sensation of “tissue tearing” during inferior alveolar nerve block indicates:
a) passage through buccinator muscle
b) passage through an area of infection
c) barb on the needle
d) large bore needle such as 19 no. needle

56. In a dental clinic after the administration of local anesthesia depression of respiration occurred. It is a manifestation of:
a) Trauma to a nerve trunk by the syringe needle
b) Toxic effects of the solution
c) Puncture of a blood vessel
d) Use of an isotonic solution

57. Symptoms of epinephrine overdose following a local anesthetic injection may include all of the following except:
a) restlessness
b) hypotension
c) apprehension
d) palpitations

58. Which of the following is the cause of allergies to local anesthetics?
a) Slow elimination
b) Improper technique
c) Slow detoxification
d) Antigen and antibody reactions

59. Accidental intravenous injection of LA which contains a vasoconstrictor may cause:
a) convulsions and palpitations
b) unconsciousness and depressed respiration
c) increased respiration
d) any of the above may occur

60. The maximum dosage of local anesthetic agent like lidocaine must be reduced when used in combination with a CNS and/respiratory depressant because, it may result in:
a) seizures
b) coma
c) death
d) All of the above

61. Hematoma formation is more frequent with:
a) inferior alveolar nerve block
b) posterior superior alveolar nerve block
c) greater palatine nerve block
d) infraorbital nerve block

62. The most significant adverse consequence of accidental intravenous administration of a local anesthetic is:
a) bronchoconstriction
b) hepatic damage
c) nerve damage
d) seizures

63. Jet injector primary use is
a) Topical anesthesia
b) Supra-periosteal anesthesia
c) Pulpal anesthesia
d) All of the above

64. Which of the following are theories of regional Analgesia?
a) Specificity theory and gate control theory
b) Specific receptor theory and gate control theory
c) Specific receptor theory and membrane expansion theory
d) Specificity theory and membrane expansion theory

65. Nerve membrane stabilization action of local anesthetic agents is due to:
a) increasing conductance of potassium ions
b) creating negative after potentials
c) preventing conductance of Na ions from the exterior of the nerve to the interior
d) preventing conductance of Na ions from the interior to the exterior of the nerve

66. When compared to the non-myelinated nerve, myelinated nerve requires:
a) higher concentration of anesthetic agent
b) lower concentration of anesthetic agent
c) same concentration of anesthetic agent
d) none of the above because no correlation

67. Myelinated nerve fibres have all of the following properties except:
a) conduction is slower in myelinated than in non-myelinated fibres
b) current discharges at nodes of ranvier
c) outer layer is of lipids
d) depolarisation occurs only at nodes of ranvier

68. Sensitivity to local anaesthetics is greater in:
a) type B fibres
b) type C fibres
c) type A delta fibres
d) fibres supplying the muscle spindles

69. The first sensation to be lost following administration of local anesthetic is:
a) Proprioception
b) Pain
c) Touch
d) Temperature

70. Of the following which tooth is most difficult to anesthetize by infiltration technique alone:
a) maxillary canine
b) maxillary central incisors
c) maxillary first molar
d) maxillary first premolar

71. Dental extraction when indicated in a controlled hemophilic should be done with:
a) nerve block like inferior alveolar
b) endotracheal general anaesthesia
c) field block
d) periodontal ligament injection of L.A

72. Inferior alveolar nerve block is absolutely contraindicated in patients suffering from one of the following disease:
a) Thrombocytopenia
b) Hemophilia
c) Hypoprothrombinemia
d) Von willebrand’s disease

73. Nerve block which is given in case of severe trismus for achieving anesthesia of inferior alveola nerve, long buccal nerve, lingual nerve, & masseteric nerve is:
a) Gow-Gates technique
b) Akinosis technique
c) V2 block
d) Conventional inferior alveolar nerve block

74. Tuberosity technique is other name of which technique
a) Vazarani-Akinosis closed mouth technique
b) Gow-Gates
c) IANB
d) GP

75. In the extraoral technique for mandibular nerve block the needle after contacting the pterygoid plate is directed:
a) anteriorly
b) posteriorly
c) superiorly
d) inferiorly

76. One wants to anesthetize the inferior alveolar nerve at the point at which it exists from the mandibular canal, so the injection site most often located in:
a) between first and second molars inferior to the root apices
b) between first and second molar superior to root apices
c) between first and second premolars inferior to root apices
d) between first and second premolars superior to root apices

77. The following anatomical land marks are useful in the closed block except:
a) Occlusal plane of occluding teeth
b) Anterior border of ramus
c) Mucogingival junction of the mandibular teeth
d) A & B

78. During the administration of posterior superior alveolar nerve block, the landmarks that guid the operator are anterior border of coronoid process &
a) anterior border of the ramus
b) mandibular 2nd premolar
c) pterygomandibular raphae
d) palatine tonsils

79. Among the following which nerve innervates the buccal gingiva of the maxillary second premolar?a) Anterior palatine nerve
b) Buccal nerve
c) Middle superior alveolar nerve
d) Posterior palatine nerve

80. The following nerves should be anesthetized for the removal of maxillary first molar
1. Anterior palatine
2. Posterior palatine
3. Anterior superior alveolar
4. Middle superior alveolar
5. Posterior superior alveolar
a) 1, 3, 5
b) 1, 4, 5
c) 2, 3, 5
d) 2, 4, 5

81. The following areas are anesthetized by the anterior palatine nerve block:
a) Part of the upper lip, lateral surface of nose and lower eyelid
b) Posterior portion of hard palate and overlying tissues upto the first premolar
c) Incisors canine and first premolar
d) Both hard and soft palates completely

82. In the extraoral infraorbital nerve block the following nerve is not involved:
a) Anterior superior alveolar
b) Middle superior alveolar
c) Sphenopalatine
d) Lateral nasal

83. Intraoral injection to block second division of the trigeminal nerve should be given in the:
a) foramen spinosum
b) foramen ovale
c) pterygopalatine fossa
d) infraorbital foramen

84. Following a maxillary tuberosity injection, within a few seconds, patient’s face becomes extremely distended and swollen on the injected side. Treatment is:
a) Incision and drainage
b) Antibiotic administration
c) Use of cold packs and pressure on
d) Antihistamine administration the side

85. Ester type of L.A. are metabolized in:
a) Liver
b) Plasma
c) Kidney
d) Lungs

86. During the administration of an inferior alveolar nerve block which of the following muscles is usually penetrated with the needle
a) Buccinator
b) Medial pterygoid
c) Lateral pterygoid
d) Masseter

87. Properties of local anesthetics include all the following EXCEPT:
a) Preferentially binds to sodium channels in open and inactivated state
b) Low affinity for channels in resting state
c) They are weak bases
d) Less effective in an environment with low extracellular pH

88. Usually hydrolysis of amide type of local anesthetic salts is facilitated by
a) tissue pH above 7.0
b) tissue pH between 5.0 and 7.0
c) tissue pH below 5.0
d) there is no relationship between pH and hydrolysis in amide type local anaesthesia

89. Of the following in which condition local anesthesia is ineffective?
a) Edema
b) Localised infection
c) Hematoma
d) Anemia

90. Sodium bicarbonate when given with local anesthetics has which of the following effect?
a) Increases rapidity of action
b) Helps intraneural spread of LA
c) Decreases onset and quality of block
d) Increases rate of drug absorption from site

91. The local anesthetic which can be used safely to patient who is allergic to both lignocaine and procaime:
a) Amethocaine
b) Bupivacaine
c) Mepivacaine
d) Bucricaine

92. Amide type of local anesthetic agents undergo biotransformation primarily in the:
a) kidney
b) liver
c) plasma
d) excreted in unaltered form

93. Which of the following can be used as local anesthetic agent for infiltration if a patient is allergic to amide and ester anesthetic derivatives:
a) Nitrous oxide
b) Bupivacaine
c) Phenylephrine
d) Diphenhydramine

94. The role of sodium bisulphate in a L.A solution is:
a) Reducing agent
b) Aesthetic agent
c) Vasoconstrictor
d) Preservative

95. Frequently which of the following constitutes in amide type local anesthesia causes allergic reaction:
a) Lignocaine hydrochloride
b) Methyl paraben
c) Adrenaline
d) Contaminants in the solution

96. Which is not a useful function of adrenaline in local anesthetic:
a) Decreased side effect of local anesthetia
b) Decreasing the duration of action of local anesthetic
c) Decreased anesthetic blood levels
d) Blood less field in surgery

97. The addition of hyaluronidase to a local anesthetic solution might:
a) increase the duration of anesthesia
b) limit the area of anesthesia
c) reduce bleeding
d) enhance diffusion of local anesthetic

98. The effect of local anesthesia can be Increased by the addition of
a) adrenaline
b) isoprenaline
c) dopamine
d) felypressin [synthetic vasopressin]

99. Among the following, which condition is a contraindication to the use of local anesthetic agent?
a) Parkinson’s disease
b) Liver damage
c) Pregnancy (3rd trimester)
d) Hypersensitivity to the drug

100. Local anesthetic cartridges contain small bubbles. These bubbles contain:
a) oxygen gas
b) carbon dioxide gas
c) nitrogen gas
d) carbon monoxide gas

101. Lidocaine is used more commonly in dentistry because lidocaine:
a) causes less depression of CNS
b) causes less cardiovascular collapse
c) causes lesser incidence of allergic reactions.
d) is 50 times more potent than procaine

102. Which of following local anesthetics has intrinsic vasoconstrictive action?
a) Cocaine
b) Procaine
c) Xylocaine
d) Bupivacaine

103. Local anesthesia used in control of post operative pain is:
a) Bupivacaine
b) Prilocaine
c) Lignocaine
d) Mepivacaine

104. The maximum depth upto which topical anesthetics are effective is?
a) 1.0-2.0 mm
b) 2.0-3.0 mm
c) 3.0-4.0 mm
d) 4.0-5.0 mm

105. In peripheral nerve block, which of the following local anesthetics has the longest duration of action?
a) Bupivacaine
b) Cocaine
c) Lignocaine
d) Prilocaine

106. Etidocaine and bupivacaine has duration of action hrs.
a) 2-4
b)5-7
c) 7-10
d) <2

107. Which of the following have the highest lipid solubility and protein binding respectively?
a) Lidocaine and prilocaine
b) Prilocaine and etidocaine
c) Etidocaine and articaine
d) Procaine and articaine

108. Most commonly used local anesthesia:
a) 1: 20,000 xylocaine Hcl
b) 1: 50,000 xylocaine Hcl
C) 1: 10,000 xylocaine Hcl
d) 1: 80,000 xylocaine Hcl

109. Toxic dose of lignocaine with adrenaline is:
a) 5 mg/kg body weight
b) 10 mg/kg body weight
c) 15 mg/kg body weight
d) 20 mg/kg body weight

110. Each cartridge contain how many ml. of anesthetic solution:
a) 0.9 ml
b) 1.2 ml
c) 1.8 ml
d) 2.2 ml

111. The amount of vasoconstrictor in 1 ml of 2% Lignocaine solution with 1:2,00,000 adrenaline is:
a) 0.5 mg
b) 0.05 mg
c) 0.005 mg
d) 0.0005 mg

112. Maximum dose of xylocaine without adrenaline that can be given in 60kg adults is:
a) 500 mg
b) 300 mg
c) 400 mg
d) 600 mg

113. The dose of epinephrine given in anaphlyaxis:
a) 0.5 mg in 1: 1000 IM
b) 0.5 mg in 1: 10,000 IM
c) 0.5 mg in 1: 500 IM
d) 1 mg in 1: 100 IM

114. Action of lignocaine is affected by all except:
a) pH at the site of injection
b) blood flow at the site of injection
c) vasoconstrictor in the L.A. solution
d) action of cholinesterase at the site of injection

115. Toxic effects seen after administration of a local anesthetic with epinephrine are probably due to anesthetic agent if the following sign is present:
a) Tachypnoea
b) Tachycardia
c) Drowsiness
d) Sweating

116. Action of toxic doses of local anesthesia on CNS can be described as:
a) first stimulating the CNS followed by depression
b) first depressing it followed by CNS stimulation
c) only depression of the CNS
d) only stimulation of the CNS

117. The enzyme responsible for the maintenance of iron in hemoglobin in a ferrous state and prevents the chances of methemoglobinemia by converting iron from ferric to ferrous state is
a) erythrocyte nucleotide diphorase
b) erythrocyte nucleotide thiophorase
c) erythrocyte nucleotide reductase
d) erythrocyte nucleotide dehydrogenase

118. With over dosage of L.A. agent, one would observe:
a) hypertension
b) hypotension
c) no change in B.P.
d) cardiac arrhythmias

119. The cause of trismus after inferior alveolar block anesthesia is
a) Damage to medial pterygoid muscle during injection
b) Myositis of the external pterygoid muscle
c) Submandibular cellulitis
d) Stretching of the pterygomandibular raphe

120. Paraesthesia during a mandibular nerve block is due to:
a) sodium conductance through the nerve
b) acid pH of the anesthetic solution
c) contact of the needle with the nerve trunk
d) poor technique

121. In systemic LA toxicity, there is:
a) post depression convulsion
b) post convulsion depression
c) convulsions
d) depression

122. Of the following which is treatment of sustained convulsive reaction to a local anaesthesia:
a) Oxygen & IV fluids
b) Diazepam & oxygen
c) Phenytoin
d) Slow acting barbiturates & oxygen

123. Toxicity of local anesthesia is reserved by:
a) IV epinephrine
b) IV nalorphine
c) IV barbiturates
d) IV sodium bicarbonate

124. Cartridges should not be permitted to soak in alcohol because it:
a) destroys vasoconstrictor
b) is less effective
c) is warm in sensation
d) diffuses though rubber cap causing contamination

125. Local anesthetic agent acts by:
a) Increasing rate of depolarization
b) Shortening rate of repolarization
c) Decrease the threshold potential
d) Increasing the threshold potential

126. Local anesthetic agent acts on:
a) Nerve membrane
b) Axoplasm
c) Epineurium
d) Perineurium

127. The most acceptable theory which explain the action of local anesthesia is:
a) Surface charge theory
b) Calcium displacement theory
c) Membrane expansion theory
d) Receptor binding theory

128. The ultimate action of binding the receptor by local anesthetic agent is brought by its:
a) Hydrophilic component
b) Lipophilic component
c) Intermediary chain
d) R.N of amide agent

129. Which characteristic of L.A. agent is responsible for its penetration into the nerve:
a) Lipid solubility
b) Water solubility
c) Its ionization
d) None of the above

130. Addition of vasoconstrictor to the local anesthetic agent causes:
a) Increase alkalinity of the solution
b) Increase acidity of the solution
c) Has no effect on the L.A.
d) None of the above

131. Sodium bisulfate used in dental L.A. cartridge acts as:
a) Antioxidant for adrenaline
b) Antioxidant for lignocaine
c) Antibacterial for lingocaine
d) Not used any more

132. Sodium bisulfates has the following effect on the L.A. Solution:
a) Slows down its onset of action
b) Deceases its duration
c) Increases its Ph
d) Has no effect

133. Increase concentration of local anesthetic agent from 2% to 4% would have:
a) Rapid onset & prolonged duration
b) Onset would not be affected but duration would be prolonged
c) No change in action
d) Rapid onset but duration would not be affected

134. Tachyphylaxis (tolerance) occurs due to:
a) Increase dose of L.A.
b) Increase dose of vasoconstrictor
c) Repeated use of L.A.
d) Allergy to sodium bisulfate

135. Which of the following belongs to ester group of local anesthesia:
a) Bupivacaine
b) Benzocaine
c) Etidocaine
d) Mepivecaine

136. Which of the following is not an ester L.A. :
a) Propoxcaine
b) Procaine
c) Prilocaine
d) Pipacaine

137. All L.A. crosses the placenta:
a) Except mepivacaine
b) Statement is true
c) Statement is false
d) Except lignocaine

138. Which of the following local anesthetics cross the blood-brain barrier:
a) Lingocaine
b) Etidocaine
c) Bupivacaine
d) All of the above