Ropivacaine

Registered South African indications: 

• Surgical anaesthesia
• Acute pain management 

Contraindications 

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to other local anaesthetics of the amide type
• Intravenous regional anaesthesia
• Obstetric paracervical anaesthesia
• Hypovolaemia

Cautions 

• Breastfeeding 
• Severe renal impairment 
• Severe hepatic impairment
• Elderly
• Major peripheral nerve blocks 
• Inflamed areas
• Partial or complete heart block 
• Cardiovascular disease 
• Head and neck blocks
• Poor general condition
• Acute porphyria
• Sodium-controlled diet 
• Prolonged administration 
• Children
• May impair ability to drive and operate machinery 

Forms avail. in SA and covered in this monograph: inj

 Surgical anaesthesia 
- Lumbar epidural administration for surgery
7.5 (mg/ml)

• Intrathecal: 113-188mg, given as a slow injection at a rate of  25–50mg/min

10 (mg/ml)

• Intrathecal: 150-200mg, given as a slow injection at a rate of  25–50mg/min

- Lumbar epidural administration for caesarean section
7.5 (mg/ml)

• Intrathecal: Initial: 100mg, given as a slow injection; Titrate by 25mg as needed; Max: 150mg

- Thoracic epidural administration to establish block for post-operative pain relief
7.5 (mg/ml)

• Intrathecal: 38-113mg, given as a slow injection

- Major nerve block
7.5 (mg/ml)

• Local infiltration: 75–300mg, given as a slow injection

- Minor nerve block
7.5 (mg/ml)

• Local infiltration: 7.5-225mg, given as a slow injection

Acute pain management

2 (mg/ml)
- Lumbar epidural administration 

• Intrathecal: Initial: 20-40mg, bolus given as a slow injection; Titrate by 20-30mg at intervals of 30min; Max treatment duration: 3 days
  OR
• Intrathecal: 12-20mg/hr, as an infusion; Max treatment duration: 3 days

- Thoracic epidural administration

• Intrathecal: 12-28mg/hr, as an infusion; Max treatment duration: 3 days

- Minor nerve block

• Local infiltration: 2-200mg, given as a slow injection

- Peripheral nerve block 

• Local infiltration: 10-20mg/hr, as an infusion or intermittent injections

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Careful aspiration before and during injection is recommended to prevent intravascular injection

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When a large dose is to be injected, a test dose of 3-5ml lignocaine with adrenaline is recommended 

Paed. forms avail. in SA and covered in this monograph: inj

Surgical anaesthesia
- Lumbar epidural administration for surgery
- Thoracic epidural administration to establish block for post-operative pain relief
- Major nerve block
- Minor nerve block 

• Younger than 12 years: Not established for use 
• Older than 12 years: See adult dosage 

Acute pain management - pre- and post-operatively 
- Single caudal epidural block below T12 in children with a body weight up to 25kg
2 (mg/ml)

• Between 0-12 years: Intrathecal: 2mg/kg, given as a slow injection

- Continuous epidural infusion in children with a body weight up to 25kg
2 (mg/ml)

• Between 0-6 months: Intrathecal: Initial: 1-2mg, bolus given as a slow injection; Maintenance: 0.2mg/kg/hr, as an infusion; Treatment duration: 72hrs 
• Between 6-12 months: Intrathecal: Initial: 1-2mg, bolus given as a slow injection; Maintenance: 0.4mg/kg/hr, as an infusion; Treatment duration: 72hrs
• Between 1-12 years: Intrathecal: Initial: 2mg, bolus given as a slow injection; Maintenance: 0.4mg/kg/hr, as an infusion; Treatment duration: 72hrs 
• Older than 12 years: See adult dosage

- Peripheral nerve block
5 (mg/ml)

• Younger than 1 year: Not established for use 
• Between 1-12 years: Local infiltration: 3mg, given as a slow injection

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Careful aspiration before and during injection is recommended to prevent intravascular injection

Pregnancy

• FDA Pregnancy Category B

Breastfeeding 

• Caution 

Renal Impairment 

• Severe: Caution; no dose adjustment recommended

Hepatic Impairment 

• Severe: Caution; dose adjustment recommended 

Elderly 

• Caution; dose adjustment recommended

Central Nervous System Disorders

• Anxiety
• Paraesthesia
• Dizziness
• Headache
• Seizures
• Light headedness
• Circumoral paraesthesia
• Numbness of the tongue
• Dysarthria
• Tremor
• Hypoaesthesia
• Dyskinesia

Cardiovascular Disorders

• Bradycardia
• Tachycardia
• Cardiac arrest
• Cardiac arrhythmias
• Hypotension
• Hypertension
• Syncope

Respiratory Disorders

• Dyspnoea

Gastrointestinal Disorders

• Nausea and vomiting

Genitourinary Disorders

• Urinary retention

Endocrine and Metabolic Disorders

• Increased temperature 
• Hypothermia
• Chills 

Musculoskeletal Disorders

• Muscle twitching
• Back pain

Immune, Blood and Lymphatic System Disorders

• Allergic reactions

Sensory Disorders

• Hyperacusis
• Tinnitus
• Visual disturbances

• Other local anaesthetics
• Lidocaine
• Mexiletine
• General anaesthetics
• Opioids
• Amiodarone
• CYP1A2 inhibitors

None routine. Specific cases may require

• Heart rate
• Blood pressure
• ECG 

Ropivacaine causes reversible reduction of the neuronal membrane's permeability to sodium ions. Consequently the depolarisation velocity is decreased and the excitable threshold increased, resulting in a local blockade of both the initiation and conduction of nerve impulses.

Injection (per ml) 2mg

• Adco Ropivacaine (Adcock)
• Naropin Polyamp (AstraZeneca) originator
• Naropin Polybag (AstraZeneca) originator

Injection (per ml) 5mg

• Naropin Polyamp (AstraZeneca) originator

Injection (per ml) 7.5mg

• Naropin Polyamp (AstraZeneca) originator

Injection (per ml) 10mg

• Naropin Polyamp (AstraZeneca) originator