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Local Anaesthetic (Amide — S-Enantiomer) Pregnancy: Apart from epidural administration for obstetrical use, there are no adequate data on the use of ropivacaine hydrochloride in human pregnancy; experimental animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Breast-feeding: no data available concerning excretion of ropivacaine hydrochloride into human breast milk. Fertility: no data available. Obstetric paracervical anaesthesia is contraindicated (§4.3).

Ropivacaine

Brand names: Naropin

Ropivacaine is a long-acting amide local anaesthetic used for surgical anaesthesia and for acute pain management via regional and epidural techniques.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Adults and children above 12 years, using ropivacaine 2 mg/ml — Lumbar epidural bolus: 20-40 mg (10-20 ml), onset 10-15 minutes, duration 0.5-1.5 hours. Lumbar epidural continuous infusion for labour pain: 12-20 mg/hour (6-10 ml/hour). Lumbar or thoracic epidural continuous infusion for postoperative pain management: 12-28 mg/hour (6-14 ml/hour). Epidural intermittent injections (top-up, e.g. labour pain management): 20-30 mg (10-15 ml) at a minimum interval of 30 minutes. Peripheral nerve block (femoral or interscalene), continuous infusion or intermittent injections for postoperative pain: 10-20 mg/hour (5-10 ml/hour). Field block (minor nerve blocks and infiltration): 2.0-200 mg (1-100 ml), onset 1-5 minutes, duration 2-6 hours. The smallest dose required to produce an effective block should be used.
Route: Perineural and epidural administration by infusion (fetched product: ropivacaine 2 mg/ml solution for infusion). Careful aspiration before and during injection; the main dose should be injected slowly or in incremental doses at a rate of 25-50 mg/min while observing vital functions and maintaining verbal contact. When a large dose is to be injected, a test dose of 3-5 ml lidocaine 2% with adrenaline 1:200,000 is recommended.
Frequency: Continuous infusion (hourly rates as above), or intermittent epidural top-ups at a minimum interval of 30 minutes
Max: Cumulative doses up to 675 mg ropivacaine hydrochloride for surgery and postoperative analgesia administered over 24 hours were well tolerated in adults, as were postoperative continuous epidural infusions at rates up to 28 mg/hour for 72 hours; in a limited number of patients higher doses of up to 800 mg/day have been administered with relatively few adverse reactions. The maximum duration of epidural block is 3 days.
Ropivacaine should only be used by, or under the supervision of, clinicians experienced in regional anaesthesia. Recommended postoperative pain technique: unless instituted preoperatively, an epidural block is induced with ropivacaine 7.5 mg/ml via an epidural catheter and analgesia is then maintained with a ropivacaine 2 mg/ml infusion at 6-14 ml (12-28 mg) per hour. In clinical studies femoral nerve block was established with 300 mg of ropivacaine 7.5 mg/ml and interscalene block with 225 mg of ropivacaine 7.5 mg/ml before surgery, with analgesia then maintained using ropivacaine 2 mg/ml at 10-20 mg per hour for 48 hours. Epidural infusion of ropivacaine 2 mg/ml alone or mixed with fentanyl 1-4 micrograms/ml has been given for up to 72 hours (the combination improved pain relief but caused opioid side effects; studied only with ropivacaine 2 mg/ml). When prolonged blocks are used, the risks of reaching a toxic plasma concentration or inducing local neural injury must be considered; stop the infusion immediately if toxic symptoms occur. Hepatic impairment: ropivacaine is metabolised in the liver and should be used with caution in severe liver disease; repeated doses may need to be reduced due to delayed elimination. §4.4 and §4.8 were truncated at the source-fetch limit and §4.5 was not retrieved in the eMC bundle.

Paediatric dose

Dose: 2 mg/kg
Route: Single caudal epidural block (ropivacaine 2 mg/ml), for blocks below T12
Frequency: Single dose
Max: The volume for single caudal epidural block and for epidural bolus doses should not exceed 25 ml in any patient
Paediatric patients 0 up to and including 12 years, ropivacaine 2 mg/ml. Single caudal epidural block, blocks below T12, in children with a body weight up to 25 kg: 2 mg/kg in a volume of 1 ml/kg. Continuous epidural infusion in children up to 25 kg — 0 up to 6 months: bolus 1-2 mg/kg (0.5-1 ml/kg) then infusion up to 72 hours at 0.2 mg/kg/hour (0.1 ml/kg/hour); 6 up to 12 months: bolus 1-2 mg/kg (0.5-1 ml/kg) then infusion up to 72 hours at 0.4 mg/kg/hour (0.2 ml/kg/hour); 1 to 12 years: bolus 2 mg/kg (1 ml/kg) then infusion up to 72 hours at 0.4 mg/kg/hour (0.2 ml/kg/hour). Doses at the low end of the bolus intervals are recommended for thoracic epidural blocks and the high end for lumbar or caudal blocks. Peripheral nerve block in infants and children aged 1-12 years: single injections (e.g. ilioinguinal nerve block, brachial plexus block) should not exceed 2.5-3.0 mg/kg; continuous infusion is recommended at 0.2-0.6 mg/kg/hour (0.1-0.3 ml/kg/hour) up to 72 hours. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on ideal body weight. More conservative doses and close monitoring are recommended for children with severe disease. Use in premature children has not been documented. Fractionation of the calculated local anaesthetic dose is recommended whatever the route. Verify against a children's formulary and local protocol before use.

Dose adjustments

Renal

Normally there is no need to modify the dose in patients with impaired renal function when used for single dose or short-term treatment. Patients with severe renal dysfunction (as with advanced liver disease or partial/complete heart conduction block) require special attention, although regional anaesthesia is frequently indicated in these patients.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Paediatric patients 0 up to and including 12 years, ropivacaine 2 mg/ml. Single caudal epidural block, blocks below T12, in children with a body weight up to 25 kg: 2 mg/kg in a volume of 1 ml/kg. Continuous epidural infusion in children up to 25 kg — 0 up to 6 months: bolus 1-2 mg/kg (0.5-1 ml/kg) then infusion up to 72 hours at 0.2 mg/kg/hour (0.1 ml/kg/hour); 6 up to 12 months: bolus 1-2 mg/kg (0.5-1 ml/kg) then infusion up to 72 hours at 0.4 mg/kg/hour (0.2 ml/kg/hour); 1 to 12 years: bolus 2 mg/kg (1 ml/kg) then infusion up to 72 hours at 0.4 mg/kg/hour (0.2 ml/kg/hour). Doses at the low end of the bolus intervals are recommended for thoracic epidural blocks and the high end for lumbar or caudal blocks. Peripheral nerve block in infants and children aged 1-12 years: single injections (e.g. ilioinguinal nerve block, brachial plexus block) should not exceed 2.5-3.0 mg/kg; continuous infusion is recommended at 0.2-0.6 mg/kg/hour (0.1-0.3 ml/kg/hour) up to 72 hours. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on ideal body weight. More conservative doses and close monitoring are recommended for children with severe disease. Use in premature children has not been documented. Fractionation of the calculated local anaesthetic dose is recommended whatever the route. Verify against a children's formulary and local protocol before use.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to the active substance, to other local anaesthetics of the amide type, or to any of the excipients
  • General contraindications related to epidural anaesthesia, regardless of the local anaesthetic used
  • Intravenous regional anaesthesia
  • Obstetric paracervical anaesthesia
  • Hypovolaemia

Side effects

  • Hypotension (very common; less frequent in children) and nausea (very common); vomiting (common, more frequent in children)
  • Headache, paraesthesia, dizziness (common); symptoms of CNS toxicity (uncommon) — convulsions, grand mal convulsions, seizures, light-headedness, circumoral paraesthesia, numbness of the tongue, hyperacusis, tinnitus, visual disturbances, dysarthria, muscular twitching, tremor — usually from inadvertent intravascular injection, overdose or rapid absorption
  • Bradycardia and tachycardia (common); hypertension (common); cardiac arrest and cardiac arrhythmias (rare)
  • Urinary retention, back pain and chills (common); dyspnoea, syncope, hypothermia, anxiety (uncommon)
  • Allergic reactions including anaphylactic reactions, anaphylactic shock, angioneurotic oedema and urticaria (rare); class-related neurological complications (neuropathy, spinal cord dysfunction such as anterior spinal artery syndrome, arachnoiditis, cauda equina) and total spinal block if an epidural dose is inadvertently given intrathecally

Interactions

  • Class III anti-arrhythmic drugs (e.g. amiodarone) — close surveillance and ECG monitoring should be considered, since cardiac effects may be additive (§4.4)
  • Other local anaesthetics or agents structurally related to amide-type local anaesthetics — toxic effects are additive; use with caution (US label)
  • Strong CYP1A2 inhibitors such as fluvoxamine — plasma clearance of ropivacaine was reduced by 70% during coadministration of fluvoxamine 25 mg twice daily for 2 days (US label)
  • Drugs associated with methaemoglobinaemia (nitrates/nitrites, other local anaesthetics, antineoplastics, dapsone, nitrofurantoin, sulfonamides, chloroquine, primaquine, phenobarbital, phenytoin, sodium valproate, paracetamol, metoclopramide, quinine, sulfasalazine) — increased risk when co-administered (US label)
  • Full eMC §4.5 was not retrieved in this source bundle

Clinical monograph

How it works

It reversibly blocks voltage-gated sodium channels in nerve fibres, inhibiting initiation and conduction of nerve impulses.

Prescribing in practice

  • Inadvertent intravascular injection or overdose can cause local anaesthetic systemic toxicity, with central nervous system and cardiac effects, so aspiration, incremental dosing and lipid-emulsion rescue availability are important safeguards.
  • It is often preferred over bupivacaine for a relatively more favourable cardiotoxicity profile and a degree of motor-sensory differentiation at lower concentrations.
  • Maximum safe doses must be individualised, and caution is needed in hepatic impairment and in the frail or elderly.

Monitoring

Monitor for early features of systemic toxicity and observe cardiovascular and neurological status after administration.

Counselling the patient

  • Report dizziness, numbness around the mouth, ringing in the ears or a metallic taste promptly.
  • Numbness and reduced movement in the blocked area are expected and will wear off.

Evidence & guidelines

Its efficacy and relative safety profile in regional and epidural anaesthesia are well established in anaesthetic literature and the SPC.

Reference: AAGBI LAST Guidelines 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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