Ropivacaine 0.75%

UNCONTROLLED WHEN PRINTED
 Introduction

Ropivacaine 0.75% is a local anaesthetic used for regional nerve blocks such as femoral nerve block. At high doses, ropivacaine produces surgical anaesthesia, while lower doses cause a sensory block. These effects begin within a few minutes and last for 2-6 hours when ropivacaine is used for field blocks.

Ropivacaine has a better safety profile than alternative local anaesthetics such as Bupivacaine.

 Indications
  • Ultrasound guided femoral nerve block in adults only
 Contraindications
  • Known allergy to local anaesthetics
 Precautions / Notes
  • Patients on anticoagulants or who have known bleeding disorders
 Preparation
Preparation
 Management
 Weight-based Calculations
 
Clear
 kg 
Mode: 
Weight: 
Cefazolin for fractures/prophylaxis
Presentation: /mL
Calculated dose:  in

Critical Care

Adult:

  • Maximum dose is 3mg/kg (or 0.4ml/kg)
  • Generally adults require 10-15ml to produce good effect from nerve block
 Special Considerations
  • Ropivacaine has a much better safety profile than alternatives especially in terms of cardiac toxicity.
  • Signs and symptoms of local anaesthetic toxicity include the following.
Mild toxicitySerious toxicity
  • Perioral tingling/paraesthesia
  • Dizziness
  • Metallic taste in mouth
  • Light-headedness
  • Cardiac arrhythmia (bradycardia/tachycardia)
  • Hypotension
  • Decreased conscious level
  • Seizures
  • Management of serious toxicity centres around an ABC approach and ALS
  • Hypotension can be managed with fluid bolus +/- inotropic support
  • Seizures should be managed with small aliquots of midazolam IV
  • For broad complex/ventricular dysrhythmias, administer Sodium Bicarbonate to restore perfusing rhythm.
  • Definitive treatment with Intralipid is available in tertiary Emergency Departments 
Presentation
  • 0.75% Ropivacaine presented as 150mg in 20mL; or 7.5mg/mL
Settings
Current mode:
Extended Care:
Colour assist:

References

El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018;11:35-44

Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011;55(2):104-110


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