Ropivacaine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : Parenteral Surgical anesth Lumbar epidural block: 0.5% soln: 75-150 mg; 0.75% soln: 112.5-187.5 mg; 1% soln: 150-200 mg. Caesarean section: 0.5% soln: 100-150 mg; 0.75% soln: 112.5-150 mg. Thoracic epidural block: 0.5% soln: 25-75 mg; 0.75% soln: 37.5-112.5 mg. Peripheral nerve block: 0.5% soln: 175-250 mg; 0.75% soln: 225-300 mg. Infiltration anaesth and field block: 0.5% soln: ≤200 mg; 0.75% soln: ≤225 mg. Acute pain Lumbar epidural block: 0.2% soln: Initial: 20-40 mg, then 20-30 mg at intervals of not less than 30 mins. Thoracic epidural block: 0.2% soln: 12-28 mg/hr as continuous infusion. Infiltration anaesth: 0.2% soln: 2-200 mg; 0.5% soln: 5-200 mg.
Dosage Details
Parenteral
Acute pain
Adult: 0.2% soln: Lumbar epidural block: 20-40 mg (10-20 mL) as an initial bolus followed by 20-30 mg (10-15 mL) at intervals of not less than 30 min. Alternatively, 12-20 mg/hr (6-10 mL/hr) as a continuous epidural infusion. Doses up to 28 mg/hr (14 mL/hr) may be used if additional pain relief is required. Thoracic epidural block: 12-28 mg/hr (6-14 mL/hr) as a continuous infusion. Infiltration anaesth: 0.2% soln: 2-200 mg (1-100 mL); or 0.5% soln: 5-200 mg (1-40 mL).

Parenteral
Surgical anaesthesia
Adult: Lumbar epidural block: 0.5% soln: 75-150 mg (15-30 mL); 0.75% soln: 112.5-187.5 mg (15-25 mL); 1% soln: 150-200 mg (15-20 mL). Caesarean section: 0.5% soln: 100-150 mg (20-30 mL); 0.75% soln: 112.5-150 mg (15-20 mL). Thoracic epidural block to establish a block for post-op pain relief: 0.5% soln: 25-75 mg (5-15 mL); 0.75% soln: 37.5-112.5 mg (5-15 mL. Peripheral nerve block: 0.5% soln: 175-250 mg (35-50 mL); 0.75% soln: 225-300 mg (30-40 mL). Infiltration anaesth and field block: 0.5% soln: Up to 200 mg (40 mL); 0.75% soln: Up to 225 mg (30 mL).
Contraindications
Hypovolaemia. Not intended for IV regional anaesth and obstetric paracervical block.
Special Precautions
Patient w/ partial or complete heart block, acute porphyria. May cause chondrolysis when given via intra-articular infusion. Severe hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Anxiety, headache, paraesthesia, dizziness, symptoms of CNS toxicity (e.g. convulsions, seizures), bradycardia, tachycardia, cardiac arrhythmias, hypotension, HTN, syncope, dyspnoea, nausea, vomiting, urinary retention, back pain, hyperthermia, rigors, hypothermia, allergic reactions.
Potentially Fatal: Cardiac arrest.
Epidural/Parenteral: B
Patient Counseling Information
May temporarily impair locomotion and alertness.
MonitoringParameters
Monitor heart rate, BP; ECG monitoring (if used w/ antiarrhythmics).
Overdosage
Symptoms: Convulsions, CNS depression, circulatory arrest, CV depression, cardiac arrest. Management: Symptomatic and supportive treatment. Maintain a patent airway w/ optimal oxygenation and ventilation. May administer anticonvulsant drugs if necessary.
Drug Interactions
Additive systemic toxic effects w/ other local anaesth or agents structurally related to amide-type local anaesth. (e.g. certain antiarrhythmics, lidocaine and mexiletine). May potentiate the adverse effects of general anaesth or opioids. Reduced plasma clearance leading to increased ropivacaine plasma levels w/ fluvoxamine and enoxacin.
Action
Description: Ropivacaine blocks both initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to Na ions, resulting in inhibition of depolarisation w/ resultant blockade of conduction.
Onset: 3-15 min (route dependent).
Duration: 3-15 hr (dose and route dependent).
Pharmacokinetics:
Distribution: Crosses the placenta. Plasma proteins binding: Approx 94%.
Metabolism: Extensively metabolised in the liver via aromatic hydroxylation by CYP1A2 isoenzyme.
Excretion: Mainly via urine (approx 1% as unchanged drug). Terminal elimination half-life: 1.8 hr.
Storage
Store between 20-25°C.
References
Anon. Ropivacaine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 24/07/2014.

Buckingham R (ed). Ropivacaine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/07/2014.

Naropin Injection (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 24/07/2014.

Naropin Injection. U.S. FDA. https://www.fda.gov/. Accessed 24/07/2014.

Disclaimer: This information is independently developed by MIMS based on Ropivacaine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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