ropivacaine

Generic Name: ropivacaine (roe PIV a kane)
Brand Name: Naropin, Naropin Polyamp, Naropin SDV, Naropin Novaplus

What is ropivacaine?

Ropivacaine is an anesthetic (numbing medicine) that blocks the nerve impulses that send pain signals to your brain.

Ropivacaine is used as a local (in only one area) anesthesia for a spinal block, also called an epidural. The medication is used to provide anesthesia during a surgery or C-section, or to ease labor pains.

Ropivacaine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ropivacaine?

Before receiving ropivacaine, tell your doctor if you have ever had an allergic reaction to any type of numbing medicine.

Tell your caregivers at once if you have a serious side effect such as: confusion, problems with speech or vision, ringing in your ears, numbness or tingling around your mouth, weak or shallow breathing, gasping, feeling unusually hot, or feeling like you might pass out.

What should I discuss with my health care provider before receiving ropivacaine?

Tell your doctor if you have ever had an allergic reaction to any type of numbing medicine.

To make sure ropivacaine is safe for you, tell your doctor if you have:

• liver disease;

• heart disease;

• kidney disease; or

• a heart rhythm disorder.

Ropivacaine is not expected to harm an unborn baby. Tell your doctor if you are pregnant.

It is not known whether ropivacaine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is ropivacaine given?

Ropivacaine is given as an injection through a needle placed into an area of your middle or lower back near your spine. You will receive this injection in a hospital or surgical setting.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving ropivacaine.

Some numbing medications can have long-lasting or delayed effects. Talk to your doctor if you have concerns about this risk. Call your doctor if you have joint pain or stiffness, or weakness in any part of your body that occurs after your surgery, even months later.

What happens if I miss a dose?

Since ropivacaine is given as needed before a surgery or other medical procedure, you are not likely to be on a dosing schedule.

What happens if I overdose?

Tell your caregivers right away if you think you have received too much of this medicine.

Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

What should I avoid after receiving ropivacaine?

Ropivacaine can cause numbness over a large portion of your body. Take care to avoid injury before the feeling has returned completely.

Ropivacaine side effects

Get emergency medical help if you have signs of an allergic reaction: hives or red skin rash; dizziness; sneezing; difficulty breathing; nausea or vomiting; sweating; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have any of these serious side effects:

• feeling anxious, restless, confused, or like you might pass out;

• problems with speech or vision;

• ringing in the ears, metallic taste, numbness or tingling around your mouth, or tremors;

• seizure (convulsions);

• weak or shallow breathing;

• slow heart rate, weak pulse; or

• fast heart rate, gasping, feeling unusually hot.

Common side effects include:

• nausea, vomiting;

• headache, back pain;

• fever;

• itching;

• numbness or tingly feeling; or

• problems with urination or sexual function.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ropivacaine dosing information

Usual Adult Dose for Local Anesthesia:

Postoperative analgesia:
Lumbar epidural method:
Initial: 75 to 200 mg injected via lumbar epidural administration. The onset of action should occur within 10 to 30 minutes and should last approximately 2 to 6 hours.
Maintenance:
12 to 28 mg/hour administered via lumbar epidural continuous infusion.

Thoracic epidural:
Initial:
25 to 75 mg injected via thoracic epidural administration.
Maintenance:
12 to 28 mg/hour administered via thoracic epidural continuous infusion.
Cumulative epidural dosages up to 770 mg over a 24 hour period for postoperative pain have been well tolerated in adult patients.

Nerve block:
A major nerve block such as a brachial plexus block, may be established by injecting 175 to 250 mg of ropivacaine into the appropriate area of the nerve. The onset of action occurs in approximately 15 to 30 minutes with a duration of 5 to 8 hours.

A field block such as a minor nerve block or infiltration, may be established by injecting 5 to 200 mg of ropivacaine. The onset of action occurs within 1 to 15 minutes with an expected duration of 2 to 6 hours.

Usual Adult Dose for Cesarean Section:

Lumbar epidural method:
100 to 150 mg injected via lumbar epidural administration. The onset of action should occur within 15 to 25 minutes and should last approximately 2 to 4 hours. It is recommended that the 0.5% solution in doses not exceeding 150 mg be employed for cesarean sections.

Usual Adult Dose for Labor Pain:

Lumbar epidural method:
Initial: 20 to 40 mg injected via lumbar epidural administration. The onset of action should occur within 10 to 15 minutes and should last approximately 0.5 to 1.5 hours.
Maintenance:
12 to 28 mg/hour administered via lumbar epidural continuous infusion.

Incremental injections, also known as top- ups, may be made by administering a dose of 20 to 30 mg per hour.

Usual Pediatric Dose for Local Anesthesia:

Caudal Block:
2 to 8 years: 2 mg/kg

Epidural Block (other than caudal block):
1.7 mg/kg

Epidural continuous infusion:
4 months to 7 years: Loading dose of 1 mg/kg followed by 0.4 mg/kg/hr continuous epidural infusion

What other drugs will affect ropivacaine?

Tell your doctor about all your current medicines and any you start or stop using, especially:

• fluvoxamine;

• ketoconazole;

• an antibiotic--ciprofloxacin, enoxacin, norfloxacin, ofloxacin; or

• a heart rhythm medication--amiodarone (Cordarone, Pacerone), dronedarone (Multaq), dofetilide (Tikosyn), ibutilide (Corvert), or sotalol (Betapace).

This list is not complete. Other drugs may interact with ropivacaine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

• Your doctor or pharmacist can provide more information about ropivacaine.