Ropivacaine

Ropivacaine is a prescription medicine used as an anesthetic during surgery or to ease labor pain.  

• Ropivacaine is available under the following different brand names: Naropin

Adult and pediatric dosage

Injectable solution

• 2mg/mL
• 5mg/mL
• 7.5mg/mL
• 10mg/mL

Epidural/Caudal Anesthesia

Adult dosage

• 75-200 mg (15-30 mL of 0.5%-1% solution)

Major Nerve Block

• 175-250 mg (35-50 mL) of 0.5% solution
• 75-300 mg (10-40 mL) of 0.75% solution

Field Block

• 5-200 mg (1-40 mL) of 0.5% solution

Labor pain

• 20-40 mg (10-20 mL) initial of 0.2% solution, Then
• 12-28 mg/hr (6-14 mL/hr) of 0.2% solution OR
• 20-30 mg/hr (10-15 mL/hr) continuous infusion of 0.2% solution

Post-Op Pain

Peripheral Nerve Block

• 5-10 mL/hr continuous infusion of 0.2% solution

Lumbar or Thoracic Epidural

• 6-14 mL/hr continuous infusion of 0.2% solution

Infiltration/ Minor Nerve Block

• 1-100 mL dose of 0.2% solution
• 1-40 mL dose of 0.5% solution

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Ropivacaine include:

• nausea,
• vomiting,
• headache,
• back pain,
• fever,
• itching,
• numbness or tingly feeling,
• problems with urination, and
• impaired sexual function.

Serious side effects of Ropivacaine include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• red skin rash,
• sneezing,
• sweating,
• anxiety,
• restlessness,
• confusion,
• lightheadedness,
• vision or speech problems,
• ringing in the ears,
• metallic taste in the mouth,
• numbness or tingling around the mouth,
• tremors,
• seizure,
• weak or shallow breathing,
• slow heart rate,
• weak pulse,
• fast heart rate,
• gasping, and
• feeling unusually hot.

Rare side effects of Ropivacaine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Ropivacaine has severe interactions with the following drug:
  • bupivacaine liposome
• Ropivacaine has serious interactions with the following drugs:
  • abametapir
  • apalutamide
  • bupivacaine implant
  • fexinidazole
  • givosiran
  • idelalisib
  • ivosidenib
  • lonafarnib
  • tucatinib
  • voxelotor
• Ropivacaine has moderate interactions with at least 24 other drugs.
• Ropivacaine has minor interactions with the following drugs:
  • hyaluronidase
  • ribociclib

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity to ropivacaine or amide-type local anesthetics, sensitivity to parabens
• Obstetrical paracervical block anesthesia

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Ropivacaine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Ropivacaine?”

Cautions

• History of malignant hyperthermia
• DO NOT use solutions with epinephrine in distal areas of the body (eg, digit, nose, ear)
• Use preservative-free preparations for spinal or epidural anesthesia
• Monitor patient's state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity
• The addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase the duration of action
• Respiratory arrest reported with the use
• Seizures reported with systemic toxicity
• Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)
• Methemoglobinemia
  • Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
  • Advise patients or caregivers to seek immediate medical attention if the patient experiences the following signs or symptoms: pale, gray, or blue-colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue Bicillin C-R and any other oxidizing agents; depending on the severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen

Pregnancy and Lactation

• Use with caution if benefits outweigh risks during pregnancy
• Lactation
  • Not known if excreted in breast milk