ropivacaine

Contraindicated in:

Hypersensitivity; cross-sensitivity with other amide local anesthetics may occur (bupivacaine, lidocaine, mepivacaine, prilocaine).

Use Cautiously in:

Glucose–6–phosphate dehydrogenase deficiency, history of methemoglobinemia, cardiac or pulmonary disease, or concurrent exposure to oxidizing agents (or metabolites of these agents) (↑ risk of methemoglobinemia);
Concurrent use of other local anesthetics;
Liver disease;
Concurrent use of anticoagulants (including low-dose heparin and low-molecular-weight heparins/heparinoids) ↑ the risk of spinal/epidural hematomas;
Pedi: Safety and effectiveness not established in children; infants <6 mo (↑ risk of methemoglobinemia).

Adv. Reactions/Side Effects ⬆ ⬇

CV: CARDIOVASCULAR COLLAPSE, arrhythmias, bradycardia, chest pain, hypertension, hypotension, tachycardia

Derm: pruritus

F and E: hypokalemia, metabolic acidosis

GI: nausea, vomiting

GU: urinary retention

Hemat: METHEMOGLOBINEMIA, anemia

MS: chondrolysis

Neuro: circumoral tingling/numbness, paresthesia, SEIZURES, anxiety, dizziness, headache, rigors

Resp: dyspnea

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA AND ANAPHYLAXIS), fever

Interactions ⬆ ⬇

Drug-drug:

Additive toxicity may occur with concurrent use of other amide local anesthetics (includinglidocaine, mepivacaine, and prilocaine).
Fluvoxamine, amiodarone, ciprofloxacin, and propofol may ↑ the effects of ropivacaine.
Concurrent use of acetaminophen, benzocaine, bupivacaine, chloroquine, cyclophosphamide, dapsone, flutamide, hydroxyurea, ifosfamide, metoclopramide, nitrofurantoin, nitroglycerin, nitroprusside, nitrous oxide, phenobarbital, phenytoin, prilocaine, primaquine, procaine, quinine, rasburicase, ropivacaine, sulfonamides, tetracaine, and valproate may ↑ risk of methemoglobinemia; monitor closely.
↑cardiac depression and toxicity with phenytoin, amiodarone, quinidine, procainamide, or propranolol.
Cimetidine, azole antifungals, clarithromycin, erythromycin, fluoxetine, fluvoxamine, nefazodone, paroxetine, protease inhibitors, propofol, ritonavir, verapamil, and propranolol may ↓ metabolism and ↑ risk of toxicity.
Lidocaine may ↑ levels of calcium channel blockers, certain benzodiazepines, cyclosporine, fluoxetine, lovastatin, simvastatin, mirtazapine, paroxetine, ritonavir, tacrolimus, theophylline, tricyclic antidepressants, and venlafaxine.
Effects of lidocaine may be ↓ by carbamazepine, phenobarbital, phenytoin, and rifampin.

Availability ⬆ ⬇

(Generic available)

Solution for injection (preservative-free): 2 mg/mL (0.2%); 5 mg/mL (0.5%); 7.5 mg/mL (0.75%); 10 mg/mL (1%)
Premixed infusion: 2 mg/mL (0.2%); 5 mg/mL (0.5%)

Route/Dosage ⬆ ⬇

Surgical Anesthesia

Epidural (Adults ): Lumbar epidural—15–30 mL of 0.5% solution or 15–25 mL of 0.75% solution or 15–20 mL of 1% solution; Lumbar epidural for cesarean section—20–30 mL of 0.5% solution or 15–20 mL of 0.75% solution; Thoracic epidural—5–15 mL of 0.5–0.75% solution.
Major nerve block(Adults ): 35–50 mL of 0.5% solution or 10–40 mL of 0.75% solution.
Field block(Adults ): 1–40 mL of 0.5% solution.

Labor Pain

Epidural (Adults ): Lumbar epidural—10–20 mL of 0.2% solution initially, then continuous infusion of 6–14 mL/hr of 0.2% solution with incremental injection of 10–15 mL/hr of 0.2% solution.

Postoperative Pain

Epidural (Adults ): Lumbar or thoracic epidural—Continuous infusion of 6–14 mL/hr of 0.2% solution.
Infiltration (minor nerve block)(Adults ): 1–100 mL of 0.2% solution or 1–40 mL of 0.5% solution.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.

Therapeutic effects:

Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Classifications ⬆ ⬇

Therapeutic Classification: epidural local anesthetics, anesthetics (topical/local)

Pharmacokinetics ⬆ ⬇

Absorption: Systemic absorption follows epidural administration, but amount absorbed depends on dose.

Distribution: If systemic absorption occurs, this agent is widely distributed and crosses the placenta.

Metabolism/Excretion: Small amounts that may reach systemic circulation are mostly metabolized by the liver; <1% excreted unchanged in the urine.

Half-Life: 4.2 hr (after epidural use).

Time/Action Profile ⬆ ⬇

(analgesia)

ROUTE	ONSET	PEAK	DURATION
Epidural	10–30 min	unknown	2–8 hr‡

‡Duration of anesthetic block.

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify nurse if signs or symptoms of systemic toxicity occur.
Advise patient to request assistance during ambulation until orthostatic hypotension and motor deficits are ruled out.
Advise females of reproductive potential to notify health care professional if pregnancy is planned ore suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇