Ropivacaine

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.