Overview
Ropivacaine is a long-acting amide local anesthetic with a duration of action of 2-6 hours. It produces reversible conduction blockade of nerve impulses by inhibiting sodium ion influx through voltage-gated sodium channels in neuronal cell membranes. It has a lower risk of cardiotoxicity compared to bupivacaine due to its S-enantiomer structure and lower lipid solubility.
Mechanism of Action
Blocks sodium ion influx through voltage-gated sodium channels in neuronal cell membranes, preventing depolarization and propagation of nerve impulses.
Indications
- Surgical anesthesia (epidural, nerve block, infiltration)
- Acute pain management (postoperative, labor pain)
- Chronic pain management (via continuous epidural infusion)
Dosage
Dosage varies by procedure: Epidural anesthesia: 15-30 mL of 0.5-1% solution; Nerve block: 5-40 mL of 0.5-0.75% solution; Infiltration: 1-100 mL of 0.2-0.5% solution. Maximum recommended dose: 200 mg (or 2.5 mg/kg) as single injection; 770 mg/24 hours for continuous infusion.
Contraindications
- Hypersensitivity to amide local anesthetics
- Severe hypotension
- Complete heart block
- Epidural anesthesia contraindications (coagulopathy, infection at injection site)
Side Effects
- Hypotension
- Bradycardia
- Nausea/vomiting
- Back pain
- Headache
- Fever
- Urinary retention
- Paresthesia
- Methemoglobinemia (rare)
Interactions
- Class I antiarrhythmics (increased cardiac toxicity)
- Other local anesthetics (additive toxicity)
- MAO inhibitors, tricyclic antidepressants (hypotension risk)
- Vasoconstrictors (epinephrine may prolong duration)