Ropivacaine

How it works

It reversibly blocks voltage-gated sodium channels on neuronal membranes, preventing the initiation and conduction of nerve impulses; it is the S-enantiomer, conferring a wider margin between sensory and motor block and less cardiotoxicity than bupivacaine.

Prescribing in practice

• Inadvertent intravascular injection can cause local anaesthetic systemic toxicity with seizures and cardiac arrest, so aspirate before and inject in fractionated increments with full resuscitation facilities and lipid emulsion immediately available.
• Add doses from concurrent local anaesthetics together and stay within the recommended maximum to avoid cumulative systemic toxicity.
• Use cautiously and at reduced exposure in the elderly, the hepatically impaired and patients with cardiac conduction disturbance or hypovolaemia.

Monitoring

Continuously observe cardiovascular and respiratory status and conscious level during and after administration for early signs of systemic toxicity or high block.

Counselling the patient

• Tell staff at once about ringing in the ears, a metallic taste, numbness around the mouth, dizziness or palpitations.
• The treated area will feel numb and weak for several hours, so take care to avoid injury or falls.

Evidence & guidelines

Ropivacaine is an established agent for surgical regional anaesthesia supported by manufacturer studies and reflected in UK anaesthetic and the SPC guidance.