Hello

1. ROPIVACAINE
Verdah Sabih
House officer
Anesthesiology dept. HFH

2. INTRODUCTION:
 Long acting amide local anesthetic with both
anesthetic and analgesic effects.
 Similar to bupivacaine & etidocaine in duration of
activity.
 Structurally similar to mapivacaine & bupivacaine.
 Decreased cardiotoxicity
 Used for regional nerve block.
 At high doses it produces surgical anesthesia and
at lower doses it produces analgesia (sensory
block) with limited motor block..

3. STRUCTURE:
 belongs to the group of local
anaesthetics, the
pipecoloxylidides and has a
propyl group on the
piperidine nitrogen atom
(compared to bupivacaine,
which has a butyl group)
 Enantiomer of propivacaine (S
stereoisomer)

4. PHARMACOKINETICS
 Onset time : 15 mins
 Duration :2-6 hrs
 Bioavailability:87%–98% (epidural)
 Metabolism: Hepatic (CYP1A2-mediated)
 Biological half-life:1.6–6 hours (varies with
administration route)
 Excretion: Renal 86%
 less lipophilic than bupivacaine less likely to
penetrate large myelinated motor fibres selective
action on the pain-transmitting A β and C nerves rather
than Aβ fibres, which are involved in motor function.
 bound to plasma proteins to an extent of 94%, mainly to
α1-acid glycoprotein.

5. MODE OF ACTION
 reversible inhibition of sodium ion influx, and
thereby blocks impulse conduction in nerve fibre.
 potentiated by dose-dependent inhibition of
potassium channels.

6. DOSAGE AND ADMINISTRATION
 Max.dose= 3mg/kg
TECHNIQUES:
 Epidural block
 Spinal block
 Infiltration anesthesia
 Peripheral nerve block

7. INDICATIONS
 Local Surgical anesthesia
 C-section
 Hip or lower limb surgery
 Peripheral nerve blocks
 Post operative pain management
 Labour pain management
 Chronic pain management

8. CONTRAINDICATIONS
 Use as intravenous regional anaesthesia (IVRA).

9. CLINICAL SIDE EFFECTS
 CNS toxicity:usually occur at lower blood plasma
concentrations
 CNS excitation,(nervousness, tingling around the
mouth, tinnitus,tremor, dizziness, blurred vision,
seizures) followed by depression(drowsiness, loss
of consciousness), respiratory depression and
apnea).
 CVS toxicity:
 hypotension, bradycardia, arrhythmias, and/or
cardiac arrest

10. INTERACTIONS WITH OTHER DRUGS
 Anti-arrhythmics: increased myocardial
depresssion
 Antidepressants:meabolism of ropivacaine
inhibited by fluvoxamine(strong inhibitors of
cytochrome P4501A2).
 other local anaesthetics or agents : (structurally
related to amide-type local anaesthetics)toxic
effects of these drugs are additive.

11. TREATMENT OF OVERDOSE:
 Celepid, a commonly available intravenouslipid
emulsion, can be effective in treating severe
cardiotoxicity.