ROPIVACAINE

Indications & Dose:

Ropivacaine is indicated for local anaesthesia including infiltration, nerve block, epidural and intrathecal anaesthesia in adults and children over 12 years. It is also indicated for peripheral nerve block and caudal epidural in children 1–12 years for surgical pain. It is also sometimes used for infiltration anaesthesia for surgical pain in children. Ropivacaine is often coadministered with fentanyl for epidural analgesia, for example in pregnant women during labour.

USUAL ADULT DOSE FOR LOCAL ANESTHESIA

Postoperative analgesia:

Lumbar epidural method: Initial: 75 to 200 mg injected via lumbar epidural administration. The onset of action should occur within 10 to 30 minutes and should last approximately 2 to 6 hours.

Maintenance: 12 to 28 mg/hour administered via lumbar epidural continuous infusion.

Thoracic epidural: Initial: 25 to 75 mg injected via thoracic epidural administration.

Maintenance: 12 to 28 mg/hour administered via thoracic epidural continuous infusion.

Cumulative epidural dosages up to 770 mg over a 24 hour period for postoperative pain have been well tolerated in adult patients.

Nerve block: A major nerve block such as a brachial plexus block, may be established by injecting 175 to 250 mg of ropivacaine into the appropriate area of the nerve. The onset of action occurs in approximately 15 to 30 minutes with a duration of 5 to 8 hours.

A field block such as a minor nerve block or infiltration, may be established by injecting 5 to 200 mg of ropivacaine. The onset of action occurs within 1 to 15 minutes with an expected duration of 2 to 6 hours.

Usual Adult Dose for Cesarean Section

Lumbar epidural method: 100 to 150 mg injected via lumbar epidural administration. The onset of action should occur within 15 to 25 minutes and should last approximately 2 to 4 hours. It is recommended that the 0.5% solution in doses not exceeding 150 mg be employed for cesarean sections.

Usual Adult Dose for Labor Pain

Lumbar epidural method:

Initial: 20 to 40 mg injected via lumbar epidural administration. The onset of action should occur within 10 to 15 minutes and should last approximately 0.5 to 1.5 hours.

Maintenance: 12 to 28 mg/hour administered via lumbar epidural continuous infusion. Incremental injections, also known as top- ups, may be made by administering a dose of 20 to 30 mg per hour.

Usual Pediatric Dose for Local Anesthesia Caudal Block: 2 to 8 years: 2 mg/kg

Epidural Block (other than caudal block): 1.7 mg/kg

Epidural continuous infusion: 4 months to 7 years: Loading dose of 1 mg/kg followed by 0.4 mg/kg/hr continuous epidural infusion

Renal Dose Adjustments: Data are not available. However, metabolites (primarily inactive) are extensively excreted in the urine. Therefore, caution is advised in patients with renal dysfunction.

Liver Dose Adjustments: There are no definitive dosing guidelines for patients with liver dysfunction; however, compared with healthy subjects, it has been shown that plasma clearance is significantly reduced (i.e., 60% lower) and halflife is significantly prolonged (i.e., 4- fold longer) in patients with chronic end-stage liver disease.

Dose Adjustments

The elderly may be more prone to decreased renal, hepatic and cardiac function potentially resulting in a greater risk for toxic side effects following ropivacaine administration. Therefore, the manufacturer recommends starting with an initial dose at the lower end of the dosage range in this population. Monitoring of renal function may also be useful. 

Contraindications:

Ropivacaine is contraindicated for intravenous regional anaesthesia (IVRA). However, new data suggested both ropivacaine (1.2-1.8 mg/kg in 40ml) and levobupivacaine (40ml of 0.125% solution) can be used, because they have less cardiovascular and central nervous system toxicity than racemic bupivacaine. 

Side Effects:

Cautions:

Precautions:

Ropivacaine should only be used by clinicians well versed in the potential toxicities that may occur with local anesthetics and the management of those toxicities. Adequate oxygen, resuscitative equipment and personnel resources should be immediately available prior to the administration of any local anesthetic.

The general condition of the patient should be optimized and an intravenous line inserted prior to receiving major blocks. All necessary precautions should be taken to prevent intravascular injection.

Ropivacaine is contraindicated in any patient with a known hypersensitivity to ropivacaine or any amide-type local anesthetic.

As with all local anesthetics, ropivacaine should be dosed in increments. Avoid rapid injection in emergency situations where a fast onset of surgical anesthesia is needed. Aspiration for blood or cerebrospinal fluid should be performed prior to epidural injection of the local anesthetic.

Ropivacaine is not recommended for the production of obstetrical paracervical block, retrobulbar block, subarachnoid block or intravenous regional block due to a lack of clinical data and experience to support such use. Use extreme caution if ropivacaine is used for local anesthesia in the head and neck area.

Ropivacaine should be used cautiously in patients with cardiovascular abnormalities since these patients may not be able to compensate for the functional changes associated with the prolongation of atrioventricular conduction induced by amide-type local anesthetics.

Interaction:

Warnings:

Adverse Effects:

– CNS effects   CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures followed by depression (drowsiness, loss of consciousness), respiratory depression and apnea).

Cardiovascular effects include hypotension, bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: