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Long-acting amide local anaesthetic

Ropivacaine hydrochloride

Brand names: Naropin

Ropivacaine is a long-acting amide local anaesthetic used for surgical anaesthesia and acute pain management, commonly via epidural, peripheral nerve block, or wound infiltration.

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: Surgical anaesthesia (lumbar epidural for surgery): 5 mg/mL (0.5%) 15-30 mL = 75-150 mg, or 10 mg/mL (1%) 15-20 mL = 150-200 mg. Major nerve block (e.g. brachial plexus): 5 mg/mL (0.5%) 35-50 mL = 175-250 mg.
Route: Epidural / regional (perineural, infiltration) injection or infusion; not for IV injection
Frequency:
Max: Cumulative dose up to 770 mg over 24 hours well tolerated in adults for postoperative pain; continuous epidural infusion at rates up to 28 mg/hour for 72 hours well tolerated
US labelling (Glenmark). Dose varies by procedure, block site and patient status; use fractional (incremental) doses and the smallest dose/concentration needed. Give an adequate test dose (3-5 mL short-acting LA with epinephrine) before complete block. Other regimens: lumbar epidural for Caesarean 0.5% 20-30 mL (100-150 mg); thoracic epidural for surgery 0.5% 5-15 mL (25-75 mg); field/minor nerve block 0.5% 5-200 mg. Labour analgesia lumbar epidural: initial 0.2% 10-20 mL (20-40 mg), continuous infusion 0.2% 6-14 mL/h (12-28 mg/h), top-ups 0.2% 10-15 mL (20-30 mg). Postoperative pain: continuous epidural infusion 0.2% 6-14 mL/h (12-28 mg/h). Contraindicated for intra-articular infusion (risk of chondrolysis). No clean paediatric per-kg dose stated in this US label.

Dose auto-extracted from 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.

Contraindications

  • Known hypersensitivity to ropivacaine or to any local anaesthetic agent of the amide type

Side effects

  • Hypotension (37%)
  • Nausea (24.8%)
  • Vomiting (11.6%)
  • Bradycardia (9.3%)
  • Fever (9.2%)
  • Methaemoglobinaemia; CNS/cardiac toxicity with excessive plasma levels or unintended intravascular injection

Interactions

  • Other local anaesthetics or agents structurally related to amide-type local anaesthetics: additive toxic effects - use with caution
  • Strong CYP1A2 inhibitors (e.g. fluvoxamine): reduce plasma clearance of ropivacaine (fluvoxamine reduced clearance by ~70%)
  • Drugs associated with methaemoglobinaemia (nitrates/nitrites, other local anaesthetics, some antineoplastics, sulfonamides, antimalarials, phenytoin, phenobarbital): increased risk of methaemoglobinaemia

Clinical monograph

How it works

It reversibly blocks voltage-gated sodium channels on neuronal membranes, preventing the initiation and propagation of action potentials and thereby producing conduction block.

Prescribing in practice

  • Inadvertent intravascular injection can cause local anaesthetic systemic toxicity (LAST) with seizures and cardiac arrest, so aspirate before injection and have lipid emulsion rescue immediately available.
  • Ropivacaine produces relatively more sensory than motor block, which is useful for labour and postoperative analgesia where ambulation is desired.
  • It is generally considered less cardiotoxic than bupivacaine, but the same maximum-dose limits and resuscitation precautions still apply.

Monitoring

Monitor the cardiovascular and central nervous systems closely during and after administration for early signs of systemic toxicity, including circumoral numbness, tinnitus, and arrhythmia.

Counselling the patient

  • Tell the patient the blocked area will feel numb and possibly weak for several hours and to protect it from injury.
  • Advise the team to report perioral tingling, metallic taste, dizziness, or visual disturbance immediately.
  • Explain that motor and sensory function should return gradually as the block wears off.

Evidence & guidelines

Ropivacaine is an established amide local anaesthetic recommended in UK regional anaesthesia practice, with management of systemic toxicity guided by AAGBI/Association of Anaesthetists guidance.

Reference: AAGBI safe practice; 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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