Ropivacaine (Orthopaedic Nerve Blocks)

The fetched SPC is 'Ropivacaine 2 mg/ml solution for infusion' (https://www.medicines.org.uk/emc/product/100394/smpc) — the 2 mg/ml strength only; the smallest dose required to produce an effective block should be used. Table applies to adults and children above 12 years. In the clinical studies described in §4.2, femoral nerve block was established with 300 mg of ropivacaine hydrochloride 7.5 mg/ml and interscalene block with 225 mg of ropivacaine hydrochloride 7.5 mg/ml before surgery, with analgesia then maintained using the 2 mg/ml strength — the 7.5 mg/ml initial block doses come from a different strength product that is not this SPC's own posology table. Other regimens in the same table: lumbar epidural bolus 2 mg/ml, 10 to 20 ml (20 to 40 mg), onset 10 to 15 minutes, duration 0.5 to 1.5 hours; lumbar epidural intermittent top-ups 10 to 15 ml (20 to 30 mg) with a minimum interval of 30 minutes; lumbar epidural continuous infusion for labour pain 6 to 10 ml/h (12 to 20 mg/h); lumbar or thoracic epidural continuous infusion for postoperative pain 6 to 14 ml/h (12 to 28 mg/h). Administration: careful aspiration before and during injection; when a large dose is to be injected a test dose of 3 to 5 ml lidocaine 2% with adrenaline 1:200,000 is recommended; inject slowly or in incremental doses at 25 to 50 mg/min while observing vital functions and maintaining verbal contact; stop the infusion immediately if toxic symptoms occur. Ropivacaine should only be used by, or under the supervision of, clinicians experienced in regional anaesthesia. Hepatic impairment: metabolised in the liver, use with caution in severe liver disease; repeated doses may need to be reduced due to delayed elimination. Where prolonged peripheral nerve blocks are used, by continuous infusion or repeated injection, the risk of reaching a toxic plasma concentration or inducing local neural injury must be considered.

Children 0 up to and including 12 years, from SPC §4.2 (no single per-kg figure covers the page's indication, so dosePerKg is left null deliberately). Peripheral nerve block, infants and children 1 to 12 years: single injections should not exceed 2.5 to 3.0 mg/kg; continuous infusion for peripheral nerve block is recommended at 0.2 to 0.6 mg/kg/h (0.1 to 0.3 ml/kg/h) for up to 72 hours; these are guidelines for children without severe disease — more conservative doses and close monitoring are recommended in children with severe disease. Single caudal epidural block for blocks below T12 in children weighing up to 25 kg: 2 mg/kg in a volume of 1 ml/kg of the 2 mg/ml solution. Continuous epidural infusion in children up to 25 kg: 0 up to 6 months, bolus 1 to 2 mg/kg (0.5 to 1 ml/kg) then infusion 0.2 mg/kg/h (0.1 ml/kg/h) for up to 72 hours; 6 up to 12 months, bolus 1 to 2 mg/kg then infusion 0.4 mg/kg/h (0.2 ml/kg/h); 1 to 12 years, bolus 2 mg/kg (1 ml/kg) then infusion 0.4 mg/kg/h (0.2 ml/kg/h). Doses at the low end are recommended for thoracic epidural blocks and at the high end for lumbar or caudal epidural blocks. In children with a high body weight a gradual reduction of dosage is often necessary and should be based on ideal body weight. Use in premature children has not been documented. Fractionation of the calculated local anaesthetic dose is recommended whatever the route. Verify all paediatric dosing against a children's formulary before use.