Ropivacaine (rINN) is a local anaesthetic drug belonging to the amino amide group. The name ropivacaine refers to both the racemate and the marketed S-enantiomer. Ropivacaine hydrochloride is commonly marketed by AstraZeneca under the brand name Naropin.
History
Ropivacaine was developed after
bupivacaine was noted to be associated with
cardiac arrest, particularly in pregnant women. Ropivacaine was found to have less
cardiotoxicity than bupivacaine in animal models.
Clinical use
Contraindications
Ropivacaine is contraindicated for intravenous regional anaesthesia (IVRA). However, new data suggested both ropivacaine (1.2-1.8 mg/kg in 40ml) and levobupivacaine (40 ml of 0.125% solution) can be used, because they have less cardiovascular and central nervous system toxicity than racemic bupivacaine.
[(Basic of Anesthesia, Robert Stoelting, page 289)]
Adverse effects
Adverse drug reactions (ADRs) are rare when it is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia, however
allergy reactions can rarely occur.
Systemic exposure to excessive quantities of ropivacaine mainly result in central nervous system (CNS) and cardiovascular effects – CNS effects usually occur at lower blood plasma concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, followed by depression (drowsiness, loss of consciousness), respiratory depression and apnea). Cardiovascular effects include hypotension, bradycardia, Heart arrhythmia, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.[Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ]
Postarthroscopic glenohumeral chondrolysis
Ropivacaine is toxic to
cartilage and their intra-articular infusions can lead to Postarthroscopic glenohumeral chondrolysis.
Treatment of overdose
As for
bupivacaine,
Intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose in animal experiments
and in humans in a process called lipid rescue.
