Local Anaesthetic (Amide — S-Enantiomer)
Pregnancy: Used for labour epidural analgesia — good safety profile
Ropivacaine
Brand names: Naropin
Adult dose
Dose: Epidural: 0.2% 6–10 mL (labour) or 0.5–0.75% (surgical); Nerve block: 0.5–0.75% (10–40 mL); Infiltration: 0.2–0.5%
Route: Epidural / Peripheral nerve block / Infiltration / Wound infiltration
Frequency: Single dose or continuous infusion
Max: 200–225 mg per dose
Lowest cardiac toxicity of the long-acting amide LAs. Slightly less potent motor block than bupivacaine — useful for labour epidurals (better sensorimotor dissociation). Preferred for ultrasound-guided nerve blocks.
Paediatric dose
Dose: 1–2 mg/kg
Route: Infiltration / Epidural / Nerve block
Frequency: Single dose
Max: 3 mg/kg (max 200 mg)
Paediatric nerve blocks under specialist guidance. Caudal: 2 mg/kg (0.2%) for children >1 year.
Dose adjustments
Renal
No dose adjustment required.
Hepatic
Caution in severe hepatic impairment.
Paediatric weight-based calculator
Paediatric nerve blocks under specialist guidance. Caudal: 2 mg/kg (0.2%) for children >1 year.
Clinical pearls
- Best sensorimotor dissociation of the long-acting LAs — maintains motor function at analgesic concentrations; ideal for ambulatory epidural analgesia
- LAST antidote: Intralipid 20% as per bupivacaine entry
- Preferred for continuous peripheral nerve blocks (e.g. femoral, adductor canal) post-operatively
Contraindications
- IV administration
- IV regional anaesthesia
Side effects
- LAST (lower risk than bupivacaine)
- Hypotension (epidural)
- Postdural puncture headache
Interactions
- Other local anaesthetics (additive toxicity)
- Fluvoxamine (CYP1A2 inhibition — increases ropivacaine levels)
Monitoring
- Signs of LAST
- Motor and sensory block level
- Haemodynamics
Reference: BNFc; BNF 90; AAGBI LAST Guidelines 2023; BNFc. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators