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| {{Drugbox|
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| | IUPAC_name = (''S'')-''N''-(2,6-dimethylphenyl)-<br />1-propylpiperidine-2-carboxamide
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| | image = Ropivacaine.png
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| | ATC_prefix=N01
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| | ATC_suffix=BB09
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| | PubChem=175805
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| | DrugBank=APRD00492
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| | CAS_number = 84057-95-4
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| | C = 17 | H = 26 | N = 2 | O = 1
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| | molecular_weight = 274.4 g/mol
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| | bioavailability = 87%–98% (epidural)
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| | metabolism = [[Liver|Hepatic]] ([[CYP1A2]]-mediated)
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| | elimination_half-life = 1.6–6 hours (varies with administration route)
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| | excretion = [[Kidney|Renal]] 86%
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| | pregnancy_AU = B1
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| | legal_AU = S4
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| | routes_of_administration = [[Parenteral]]
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| }}
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| {{SI}}
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| {{CMG}}
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| ==Overview==
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| '''Ropivacaine''' ([[International Nonproprietary Name|rINN]]) ({{pronEng|roʊˈpɪvəkeɪn}}) is a [[local anaesthetic]] drug belonging to the [[amino]] [[amide]] group. The name ropivacaine refers to both the [[racemate]] and the marketed ''S''-[[enantiomer]]. '''Ropivacaine hydrochloride''' is commonly marketed by [[AstraZeneca]] under the [[trade name]] '''Naropin'''.
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| ==History==
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| Ropivacaine was developed after [[bupivacaine]] was noted to be associated with [[cardiac arrest]] in 0.5–0.75% of cases, particularly in pregnant women. Ropivacaine was found to have less cardiotoxicity than bupivacaine in animal models.
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| ==Clinical use==
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| ===Indications===
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| Ropivacaine is indicated for local anaesthesia including infiltration, [[nerve block]], [[epidural]] and [[intrathecal]] anaesthesia in adults and children over 12 years. It is also indicated for peripheral nerve block and [[caudal]] epidural in children 1–12 years for surgical pain. It is also sometimes used for infiltration anaesthesia for surgical pain in children.
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| Ropivacaine is often co-administered with [[fentanyl]] for epidural [[analgesia]], for example in pregnant women during [[Childbirth|labour]].
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| ==Contraindications==
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| Ropivacaine is contraindicated for IV regional anaesthesia (IVRA).
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| ==Adverse effects==
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| [[Adverse drug reaction]]s (ADRs) are rare when it is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia, however [[allergy|allergic]] reactions can rarely occur.
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| Systemic exposure to excessive quantities of ropivacaine mainly result in [[central nervous system]] (CNS) and [[cardiovascular]] effects – CNS effects usually occur at lower [[blood plasma]] concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, [[tinnitus]], tremor, dizziness, blurred vision, [[seizure]]s) followed by depression (drowsiness, loss of consciousness, [[respiratory depression]] and [[apnea]]). Cardiovascular effects include [[hypotension]], [[bradycardia]], [[arrhythmia]]s, and/or [[cardiac arrest]] – some of which may be due to [[Hypoxia (medical)|hypoxemia]] secondary to respiratory depression.<ref name="AMH2006">Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3</ref>
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| ==Treatment of overdose: "[[Lipid rescue]]"==
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| As for [[bupivacaine]], there is evidence that [[Intralipid]], a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose in animal experiments<ref name="Weinberg2003">Weinberg, G, Ripper, R, Feinstein, DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003;28:198-202. PMID 12772136</ref> and in humans.<ref name="Picard2006">Picard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9. PMID 16430560</ref><ref name="Rosenblatt2006">Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8. PMID 16810015</ref><ref name="Litz2006">Litz, RJ, Popp M, Stehr S N, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006;61:800-1.</ref>
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| ==References==
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| {{reflist|2}}
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| {{Local anesthetics}}
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| [[Category:Local anesthetics]]
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| [[Category:Obstetrics]]
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| [[de:Ropivacain]]
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| [[fr:Ropivacaïne]]
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| [[pt:ropivacaína]]
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| {{WH}}
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| {{WS}}
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