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
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