ROPIVACAINE HYDROCHLORIDE
(ro-piv'i-cane)
Naropin
Classifications: central nervous system agent; local anesthetic (ester-type)
Prototype: Procaine HCl
Pregnancy Category: B

Availability

2 mg/mL, 5 mg/mL, 7.5 mg/mL, 10 mg/mL injection

Actions

Blocks the generation and conduction of nerve impulses, probably by increasing the threshold for electrical excitability.

Therapeutic Effects

Local anesthetic action produces loss of sensation and motor activity in areas of the body close to the injection site.

Uses

Local and regional anesthesia, postoperative pain management, anesthesia/pain management for obstetric procedures.

Contraindications

Hypersensitivity to ropivacaine or any local anesthetic of the amide type; generalized septicemia, inflammation or sepsis at the proposed injection site; cerebral spinal diseases (e.g., meningitis); heart block, hypotension, hypertension, GI hemorrhage.

Cautious Use

Pregnancy (category B), lactation, debilitated, older adult, or acutely ill patients; arrhythmias, shock.

Route & Dosage

Surgical Anesthesia
Adult: Epidural 25–200 mg (0.5–1% solution) Nerve block 5–250 mg (0.5%, 0.75% solution)

Labor Pain
Adult: Epidural 20–40 mg (0.2% solution)

Postoperative Pain Management
Adult: Epidural 12–20 mg/h (0.2% solution) Infiltration 2–200 mg (0.2–0.5% solution)

Administration

Intrathecal

Avoid rapid injection of large volumes of ropivacaine. Incremental doses should always be used to achieve the smallest effective dose and concentration.
Use an infusion concentration of 2 mg/mL (0.2%) for postoperative analgesia.
Do not use disinfecting agents containing heavy metal ions (e.g., mercury, copper, zinc, etc.) on skin insertion site or to clean the ropivacaine container top.
Discard continuous infusions solution after 24 h; it contains no preservatives.
Store unopened at 20°–25° C (68°–77° F).

Adverse Effects (1%)

Body as a Whole: Pain, fever, rigors, hypoesthesia. CNS: Paresthesia, headache, dizziness, anxiety. CV: Hypotension, bradycardia, hypertension, tachycardia, chest pain, fetal bradycardia. GI: Nausea. Skin: Pruritus. Urogenital: Urinary retention, oliguria. Hematologic: Anemia.

Interactions

Drug: Additive adverse effects with other local anesthetics.

Pharmacokinetics

Onset: 1–30 min (average 10–20 min) depending on dose/route of administration. Duration: 0.5–8 h depending on dose/route of administration. Distribution: 94% protein bound. Metabolism: Metabolized in the liver by CYP1A. Elimination: Excreted in urine. Half-Life: 1.8–4.2 h.

Nursing Implications

Assessment & Drug Effects

Monitor carefully cardiovascular and respiratory status throughout treatment period. Assess for hypotension and bradycardia.
Report immediately S&S of CNS stimulation or CNS depression.

Patient & Family Education

Report any of the following to physician immediately: restlessness, anxiety, tinnitus, blurred vision, tremors.
Do not breast feed without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug