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What is Ropivacaine
Ropivacaine is a long-acting, amide-type local anesthetic. Its structure and pharmacokinetics are similar to those of bupivacaine; however, ropivacaine appears to be less arrhythmogenic than bupivacaine.
Ropivacaine is the S-isomer form, whereas bupivacaine is the R- isomer. In contrast to other local anesthetics, the systemic absorption of ropivacaine is not affected by the addition of epinephrine.
Also, the presence of epinephrine does not significantly affect the time to onset or duration of action of ropivacaine.
Some studies have shown less motor blocking effects and a shorter duration of action with ropivacaine than with bupivacaine. Ropivacaine was granted final FDA approval October 3, 1996 and was previously approved in 15 other countries.
Brand Names
- Naropin
- Ropivacaine
Indications
- brachial plexus block
- Caesarean section anesthesia
- epidural anesthesia
- infiltration anesthesia
- local anesthesia
- nerve block anesthesia
- obstetric anesthesia
- ophthalmic anesthesia
- peripheral nerve block
- regional anesthesia
- severe pain
Side Effects
- agitation
- amnesia
- anaphylactoid reactions
- anemia
- angina
- anxiety
- asthenia
- atrial fibrillation
- AV block
- back pain
- blurred vision
- bradycardia
- bronchospasm
- cardiac arrest
- chest pain (unspecified)
- chills
- chondrolysis
- coma
- confusion
- cough
- decreased uterine contractility
- depression
- diplopia
- dizziness
- drowsiness
- dyskinesia
- dyspnea
- edema
- emotional lability
- erythema
- fecal incontinence
- fetal acidosis
- fetal bradycardia
- fetal distress
- fever
- hallucinations
- headache
- hyperhidrosis
- hypertension
- hypoesthesia
- hypoglycemia
- hypokalemia
- hypomagnesemia
- hypotension
- hypothermia
- hypotonia
- infection
- injection site reaction
- insomnia
- jaundice
- laryngeal edema
- libido decrease
- malaise
- malignant hyperthermia
- meningitis
- methemoglobinemia
- muscle paralysis
- myalgia
- myocardial infarction
- nausea
- nightmares
- oliguria
- orthostatic hypotension
- palpitations
- paresis
- paresthesias
- phlebitis
- premature ventricular contractions (PVCs)
- pruritus
- pulmonary embolism
- respiratory arrest
- respiratory depression
- restlessness
- rhinitis
- seizures
- sinus tachycardia
- sneezing
- syncope
- tachypnea
- tenesmus
- thrombosis
- tinnitus
- tremor
- urinary incontinence
- urinary retention
- urticaria
- ventricular fibrillation
- ventricular tachycardia
- vertigo
- visual impairment
- vomiting
- weakness
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- amide local anesthetic hypersensitivity
- anticoagulant therapy
- AV block
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- coagulopathy
- continuous intraarticular infusion administration
- dehydration
- eclampsia
- fetal distress
- fetal prematurity
- G6PD deficiency
- geriatric
- head and neck anesthesia
- heart failure
- hepatic disease
- hypotension
- hypovolemia
- infants
- infection
- intraarterial administration
- intrathecal administration
- intravenous administration
- labor
- methemoglobinemia
- myasthenia gravis
- neonates
- neurological disease
- obstetric delivery
- paracervical nerve block
- pregnancy
- pudendal nerve block
- pulmonary disease
- QT prolongation
- sepsis
- shock
- spinal anesthesia
- thrombocytopenia
Interactions
- Acebutolol
- Acetaminophen
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetaminophen; Tramadol
- Alfentanil
- Ambenonium Chloride
- Aminosalicylate sodium, Aminosalicylic acid
- Amyl Nitrite
- Aprepitant, Fosaprepitant
- Articaine; Epinephrine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
- Atenolol; Chlorthalidone
- Atracurium
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Bendroflumethiazide; Nadolol
- Benzhydrocodone; Acetaminophen
- Benzocaine
- Benzocaine; Butamben; Tetracaine
- Benzonatate
- Beta-adrenergic blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Boceprevir
- Brimonidine; Timolol
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carteolol
- Carvedilol
- Chloroprocaine
- Chloroquine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Cimetidine
- Ciprofloxacin
- Cisatracurium
- Cobicistat
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Cyclophosphamide
- Dapsone
- Daratumumab; Hyaluronidase
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Donepezil
- Donepezil; Memantine
- Dorzolamide; Timolol
- Doxacurium
- Edrophonium
- Elbasvir; Grazoprevir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Erythromycin; Sulfisoxazole
- Esmolol
- Fentanyl
- Flutamide
- Fluvoxamine
- Fosphenytoin
- Galantamine
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Homatropine; Hydrocodone
- Hyaluronidase
- Hyaluronidase, Recombinant; Immune Globulin
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyurea
- Ibuprofen; Oxycodone
- Idelalisib
- Ifosfamide
- Isocarboxazid
- Isosorbide Dinitrate, ISDN
- Isosorbide Mononitrate
- Ketoconazole
- Labetalol
- Levobetaxolol
- Levobunolol
- Levomethadyl
- Levorphanol
- Lidocaine
- Lidocaine; Prilocaine
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Magnesium Salts
- Meperidine
- Meperidine; Promethazine
- Mepivacaine
- Mepivacaine; Levonordefrin
- Methadone
- Metoclopramide
- Metoprolol
- Minocycline
- Mitotane
- Mivacurium
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Neostigmine
- Neuromuscular blockers
- Nitrates
- Nitrofurantoin
- Nitroglycerin
- Obeticholic Acid
- Oxycodone
- Oxymorphone
- Pancuronium
- Pazopanib
- Peginterferon Alfa-2b
- Penbutolol
- Penicillin G Benzathine; Penicillin G Procaine
- Penicillin G Procaine
- Phenelzine
- Phenobarbital
- Phenytoin
- Physostigmine
- Pindolol
- Prilocaine
- Prilocaine; Epinephrine
- Primaquine
- Primidone
- Procarbazine
- Propoxyphene
- Propranolol
- Pyrimethamine; Sulfadoxine
- Quinine
- Rapacuronium
- Rasburicase
- Remifentanil
- Rituximab; Hyaluronidase
- Rocuronium
- Rofecoxib
- Selegiline
- Simeprevir
- Succinylcholine
- Sufentanil
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfisoxazole
- Sulfonamides
- Tacrine
- Telaprevir
- Telotristat Ethyl
- Tetracaine
- Theophylline, Aminophylline
- Thiabendazole
- Timolol
- Tranylcypromine
- Trastuzumab; Hyaluronidase
- Tubocurarine
- Valproic Acid, Divalproex Sodium
- Vecuronium
- Zileuton