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NERVOUS SYSTEM › ANESTHETICS › ANESTHETICS, LOCAL › Amides
ropivacaine
N01BB09
Forms & Strengths
- Injectable solution: 2 mg/mL (0.2%)
- Injectable solution: 5 mg/mL (0.5%)
- Injectable solution: 7.5 mg/mL (0.75%)
- Injectable solution: 10 mg/mL (1.0%)
Adult Dosing
- Epidural block for surgery: 15 to 200 mg (2% to 0.5% solutions)
- Epidural labor analgesia: 2 to 28 mg/hour (0.2% solution continuous infusion)
- Peripheral nerve block: 5 to 300 mg (0.5% to 0.75% solutions)
- Local infiltration: 2 to 200 mg (0.2% to 0.5% solution)
Pediatric Dosing
- Caudal epidural block in children (ages 1-12): 1 to 2 mg/kg (0.2% or 0.25% solution)
- Safety and efficacy in neonates and infants under 6 months have not been established
Indications
- Production of local or regional anesthesia for surgery
- Acute pain management (continuous epidural infusion or patient-controlled epidural analgesia for labor and postpartum)
- Major nerve block
- Local infiltration
Mechanism of Action
- Long-acting amino-amide local anesthetic
- Reversibly blocks sodium ion channels in nerve fibers, preventing propagation of the action potential
- Suppresses sensory, motor, and sympathetic nerve fibers with greater affinity for sensory fibers at lower concentrations
Contraindications
- Hypersensitivity to local anesthetics of the amide type
- Obstetric paracervical block anesthesia (associated with fetal bradycardia and death)
- Intravenous regional anesthesia (Bier block) due to systemic toxicity risk
Adverse Reactions
- Central nervous system: Paresthesia, dizziness, headache, anxiety, tremors, seizures
- Cardiovascular: Hypotension, bradycardia, arrhythmias, cardiac arrest
- Gastrointestinal: Nausea, vomiting
- Other: Urinary retention, fever, pruritus
Drug Interactions
- CYP1A2 inhibitors (e.g., fluvoxamine, enoxacin): May decrease clearance of ropivacaine
- Other local anesthetics or structurally related antiarrhythmic drugs (e.g., lidocaine, mexiletine): Additive systemic toxicity
- General anesthetics and opioids: May enhance cardiovascular and central nervous system depression
Curated Content: Needs Vetting Before Put to Clinical Use