Ropivacaine

Indications
 Parenteral
Surgical anaesthesia
Adult: Lumbar epidural block: 75-150 mg (15-30 ml) as a 0.5% solution or 112.5-187.5 mg (15-25 ml) as a 0.75% solution or 150-200 mg (15-20 mL) as a 1% solution. Caesarean section: 100-150 mg (20-30 ml) as a 0.5% solution or 112.5-150 mg (15-20 ml) as a 0.75% solution. Thoracic epidural block to establish a block for postoperative pain relief: 25-75 mg (5-15 ml) as a 0.5% solution or 37.5-112.5 mg (5-15 ml) as a 0.75% solution. Peripheral nerve block: 175-250 mg (35-50 ml) as a 0.5% solution or 225-300 mg (30-40 ml) as a 0.75% solution. Infiltration anesthesia and field block: Up to 200 mg (40 ml) as a 0.5% solution or up to 225 mg (30 ml) as a 0.75% solution.
Child: Management of pre- and postoperative pain: ≥1 yr: Caudal epidural block: (as a 0.2% solution) 2 mg/kg (1 ml/kg).
Parenteral
Acute pain
Adult: Lumbar epidural block: (as a 0.2% solution) 20-40 mg (10-20 ml) as an initial bolus followed by 20-30 mg (10-15 ml) at intervals of ≥30 min. Alternatively, 12-20 mg/hr (6-10 ml/hr) as a continuous epidural infusion. Up to 28 mg/hr (14 ml/hr) may be used if additional pain relief is required. Thoracic epidural block: (as a 0.2% solution) 12-28 mg/hr (6-14 ml/hr) as a continuous infusion. Infiltration anesthesia: 2-200 mg (1-100 ml) as a 0.2% solution or 5-200 mg (1-40 ml) as a 0.5% solution.
Contraindications
 Complete heart block; severe hypotension; pyogenic infection at or near the skin. Application to inflamed or infected tissues or to damaged skin mucosa; instillation into the middle ear. Epidural and spinal block should not be used in patients with cerebrospinal diseases, cardiogenic or hypovolaemic shock or altered coagulation status. IV regional anaesthesia (Bier's block) and paracervical block in obstetrics.
Warnings / Precautions
 Elderly; debilitated patients; child; epilepsy; impaired cardiac conduction or respiratory function; shock; hepatic impairment; myasthenia gravis. Do not to rub or touch the eye while anaesthesia persists. Avoid application for prolonged periods and to extensive areas. Pregnancy and lactation.
Adverse Reactions
 Restlessness; excitement; nervousness; paraesthesias; dizziness; tinnitus; blurred vision; nausea and vomiting; muscle twitching; tremors; convulsions; hypotension; bradycardia; arrhythmias; cardiac arrest.
Drug Interactions
 Itraconazole, ketoconazole or clarithromycin may reduce clearance of ropivacaine. Increased metabolism when used with rifampicin. Clearance is inhibited when used with fluvoxamine or ciprofloxacin. Increased risk of toxicity when used with other local anaesthetics.
See Below for More ropivacaine Drug Interactions
Mechanism of Actions
 Ropivacaine blocks both initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, resulting in inhibition of depolarisation with resultant blockade of conduction.
Onset: Anaesthesia (route dependent): 3-15 min.
Duration: Dose- and route-dependent: 3-15 hr.
Distribution: 94% bound to plasma proteins.
Metabolism: Extensively metabolised in the liver, primarily by aromatic hydroxylation.
Excretion: Terminal half-life: 1.8 hr. Mainly excreted in the urine with 1% of a dose as unchanged drug.
Storage Conditions
 Parenteral: Store at 20-25°C.
ATC Classification
 N01BB09 - ropivacaine ; Belongs to the class of amides. Used as local anesthetics.
Storage
 Parenteral: Store at 20-25°C.
Available As
  • Ropivacaine 2 mg
  • Ropivacaine 5 mg
  • Ropivacaine 7.5 mg

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