Ropivacaine

Ropivacaine is an active ingredient for epidural anesthesia. It is a local anesthetic and is used for surgical procedures and caesarean sections. Ropivacaine is a derivative of bupivacaine, but has a slower effect in comparison, with a longer plasma half-life of approx. 4 hours, meaning that ropivacaine has a longer effect. It can also be used for long-term treatment of pain by repeatedly injecting ropivacaine into the epidural space. Ropivacaine is usually present as ropivacaine hydrochloride monohydrate and is a lipophilic local anesthetic of the amide type.

Ropivacaine works by changing the permeability of the cell membrane for sodium ions. An influx of sodium ions is then no longer possible. As a result, the action potential and, consequently, the excitation conduction also ceases. The affected area is completely pain-free. Ropivacaine is reversible, which means that the effect can be reversed. Due to the few side effects on the heart, ropivacaine is often used in obstetrics.

Ropivacaine is metabolized in the liver via the enzyme CYP1A2. The metabolism is highly dependent on the dosage and the patient's condition. It has a plasma protein binding of 94%. 86% is excreted in the urine.

The half-life of ropivacaine, i.e. the time the body needs to excrete half of the active substance, is approx. 4 hours.

Always take Ropivacaine exactly as described in the package leaflet or as advised by your doctor.

Ropivacaine is only administered in the form of injections.

The usual recommended dose for surgical procedures is between 25 mg and 200 mg.

The recommended dose for caesarean section is between 100 mg and 150 mg.

The usual dose for childbirth is between 20 mg and 40 mg.

Ropivacaine is either administered epidurally, i.e. into the epidural space surrounding the spinal cord, or injected locally.

It must NOT be injected into the blood vessels (intravascularly).

The following side effects may occur:

Very common:

• allergic reactions
• low blood pressure
• nausea

Frequent:

• Tingling
• dizziness
• Headache
• Cardiac arrhythmia
• High blood pressure
• vomiting
• difficulty urinating
• Fever and chills
• Back pain

Occasionally:

• Anxiety
• Reduced sensitivity of the skin
• Fainting
• Difficulty breathing
• Reduced body temperature (hypothermia)

Rarely:

• Cardiac arrest
• Irregular heartbeat (arrhythmia)

Frequency unknown:

• Numbness
• Involuntary muscle movements
• Nerve damage

Overdosing into the epidural space can lead to anesthesia of the whole body!

Ropivacaine may have the following side effects in children in addition to those mentioned above:

• increased frequency of vomiting compared to adults
• Reduced frequency of low blood pressure compared to adults

Interactions may occur if the following medicines are taken at the same time:

• other local anesthetics
• morphine
• codeine
• medicines for the treatment of arrhythmias
• medicines for the treatment of depression
• for antibiotics

Ropivacaine must NOT be used in the following cases:

• in case of allergy to ropivacaine
• allergy to other local anesthetics
• in case of reduced blood volume (hypovolemia)
• for administration into blood vessels or the cervix

In principle, there are no age restrictions for ropivacaine, but not all dosages have been tested for all parts of the body in children .

Increased caution is required for newborns, as they are more sensitive to ropivacaine.

Increased caution is also required in children up to 12 years of age because ropivacaine has not been tested for anesthetizing all parts of the body. Your doctor may have to change the dosage or use Ropivacaine off-label.

An "off-label" use is the administration of a drug outside the use authorized by the drug authority. This off-label use is only to be carried out on the instructions of a doctor, or by the doctor himself.

Ropivacaine may have the following side effects in children in addition to those mentioned above:

• increased incidence of vomiting compared to adults
• reduced incidence of low blood pressure compared to adults

Ropivacaine can be used as indicated during pregnancy.

There is no increased risk of malformation in the 1st trimester of pregnancy.

There is no increased risk of birth complications in the 2nd and 3rd tr imester of pregnancy or at birth. Examinations immediately after birth were normal for both the newborn and the mother.

There are many reports on this.

Even though ropivacaine can be used during pregnancy and childbirth, the related bupivacaine should still be given priority.

Ropivacaine can be used as indicated during breastfeeding. It passes into breast milk in very small quantities, but studies have shown no abnormalities in the infant. The tests showed values of 246 ng/ml and 301 ng/ml in breast milk. This corresponds to a value of 0.000000246 g/ml and 0.000000301 g/ml respectively.