Educational Blog about Anesthesia, Intensive care and Pain management

Ropivacaine (Naropin®)

Ropivacaine (Naropin®)



➧ Ropivacaine is a long-acting amide local anesthetic (LA) drug. The name ropivacaine refers to both the racemic mixture and the marketed S-enantiomer.

➧ It produces effects similar to other LAs via reversible inhibition of sodium ion influx in nerve fibers.

Advantages:

➧ Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibers, resulting in a relatively reduced motor blockade. Thus, ropivacaine has a greater degree of motor-sensory differentiation, which could be useful when the motor blockade is undesirable. 

➧ The reduced lipophilicity is also associated with decreased potential for central nervous system toxicity and cardiotoxicity.

Uses:

1-Epidural anesthesia 

2-Peripheral nerve block 

3-Postoperative pain management 

4-Intrathecal hyperbaric solution of ropivacaine was tried and found to be less potent than bupivacaine and resulted in a faster onset and recovery from the blocks. Hyperbaric ropivacaine solutions are not commercially available.

Contraindications:

1-Intravenous regional anesthesia (IVRA): However, recent data suggested that ropivacaine (1.2-1.8 mg/kg in 40 ml) can be used, because it has less cardiovascular and central nervous system toxicity than racemic bupivacaine. 

2-Intra-articular infusion: Ropivacaine is toxic to cartilage and its intra-articular infusion can lead to Postarthroscopic glenohumeral chondrolysis.

Adverse effects:

a) CNS effects: occur at lower blood plasma concentrations; CNS excitation followed by depression. 

-CNS excitation: nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures. 

-CNS depression: drowsiness, loss of consciousness, respiratory depression, and apnea. 

b) Cardiovascular effects: occurs at higher blood plasma concentrations. 

-Hypotension, bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.

Treatment of overdose:

➧ As for bupivacaine, Intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anesthetic overdose in animal experiments and in humans in a process called lipid rescue.
Read more ☛ LA Toxicity