Ropivacaine

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

  1. brachial plexus block
  2. Caesarean section anesthesia
  3. epidural anesthesia
  4. infiltration anesthesia
  5. local anesthesia
  6. nerve block anesthesia
  7. obstetric anesthesia
  8. ophthalmic anesthesia
  9. peripheral nerve block
  10. regional anesthesia
  11. severe pain

Side Effects

  1. agitation
  2. amnesia
  3. anaphylactoid reactions
  4. anemia
  5. angina
  6. anxiety
  7. asthenia
  8. atrial fibrillation
  9. AV block
  10. back pain
  11. blurred vision
  12. bradycardia
  13. bronchospasm
  14. cardiac arrest
  15. chest pain (unspecified)
  16. chills
  17. chondrolysis
  18. coma
  19. confusion
  20. cough
  21. decreased uterine contractility
  22. depression
  23. diplopia
  24. dizziness
  25. drowsiness
  26. dyskinesia
  27. dyspnea
  28. edema
  29. emotional lability
  30. erythema
  31. fecal incontinence
  32. fetal acidosis
  33. fetal bradycardia
  34. fetal distress
  35. fever
  36. hallucinations
  37. headache
  38. hyperhidrosis
  39. hypertension
  40. hypoesthesia
  41. hypoglycemia
  42. hypokalemia
  43. hypomagnesemia
  44. hypotension
  45. hypothermia
  46. hypotonia
  47. infection
  48. injection site reaction
  49. insomnia
  50. jaundice
  51. laryngeal edema
  52. libido decrease
  53. malaise
  54. malignant hyperthermia
  55. meningitis
  56. methemoglobinemia
  57. muscle paralysis
  58. myalgia
  59. myocardial infarction
  60. nausea
  61. nightmares
  62. oliguria
  63. orthostatic hypotension
  64. palpitations
  65. paresis
  66. paresthesias
  67. phlebitis
  68. premature ventricular contractions (PVCs)
  69. pruritus
  70. pulmonary embolism
  71. respiratory arrest
  72. respiratory depression
  73. restlessness
  74. rhinitis
  75. seizures
  76. sinus tachycardia
  77. sneezing
  78. syncope
  79. tachypnea
  80. tenesmus
  81. thrombosis
  82. tinnitus
  83. tremor
  84. urinary incontinence
  85. urinary retention
  86. urticaria
  87. ventricular fibrillation
  88. ventricular tachycardia
  89. vertigo
  90. visual impairment
  91. vomiting
  92. 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
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