No

Local Anesthetic

Local anesthetic (injectable) for use in surgery, postoperative pain management, and obstetrical procedures when local or regional anesthesia is needed. It can be administered via local infiltration, epidural block and epidural infusion, or intermittent bolus.

B

Hypersensitivity to amide-type local anesthetics (eg, bupivacaine, mepivacaine, lidocaine); septicemia, severe hypotension and for spinal anesthesia, in the presence of complete heart block

Use with caution in patients with liver disease, cardiovascular disease, neurological or psychiatric disorders; it is not recommended for use in emergency situations where rapid administration is necessary

>10% (dose and route related):

Cardiovascular: Hypotension, bradycardia

Gastrointestinal: Nausea, vomiting

Neuromuscular & skeletal: Back pain

Miscellaneous: Shivering

1% to 10% (dose related):

Cardiovascular: Hypertension, tachycardia

Central nervous system: Headache, dizziness, anxiety, lightheadedness

Neuromuscular & skeletal: Hypoesthesia, paresthesia, circumoral paresthesia

Otic: Tinnitus

Respiratory: Apnea

Treatment is primarily symptomatic and supportive. Termination of anesthesia by pneumatic tourniquet inflation should be attempted when the agent is administered by infiltration or regional injection.

Seizures commonly respond to diazepam, while hypotension responds to I.V. fluids and Trendelenburg positioning

Bradyarrhythmias (when the heart rate is <60) can be treated with I.V., or S.C. atropine 15 mcg/kg

With the development of metabolic acidosis, I.V. sodium bicarbonate 0.5-2 mEq/kg and ventilatory assistance should be instituted

Methemoglobinemia should be treated with methylene blue 1-2 mg/kg in a 1% sterile aqueous solution I.V. push over 4-6 minutes repeated up to a total dose of 7 mg/kg

CYP2D6 enzyme substrate

Increased toxicity (possible but not yet reported): Drugs that decrease cytochrome P-450 1A enzyme function

Epidural infusions can be used less than or equal to 24 hours

Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction

Onset of anesthesia (dependent on route administered): Within 3-15 minutes generally

Duration of action (dependent on dose and route administered): 3-15 hours generally

Metabolism: In the liver

Half-life: Epidural: 5-7 hours; I.V.: 2.4 hours

Elimination: 86% of metabolites are excreted in urine

Dose varies with procedure, onset and depth of anesthesia desired, vascularity of tissues, duration of anesthesia, and condition of patient

Lumbar epidural for surgery: 15-30 mL of 0.5% to 1%

Lumbar epidural block for cesarean section: 20-30 mL of 0.5%

Thoracic epidural block for postoperative pain relief: 5-15 mL of 0.5%

Major nerve block: 35-50 mL dose of 0.5% (175-250 mg)

Field block: 1-40 mL dose of 0.5% (5-200 mg)

Lumbar epidural for labor pain: Initial: 10-20 mL 0.2%; continuous infusion dose: 6-14 mL/hour of 0.2% with incremental injections of 10-15 mL/hour of 0.2% solution

No information available to require special precautions

No effects or complications reported

Infusion, as hydrochloride: 2 mg/mL (100 mL, 200 mL)

Injection, as hydrochloride (single dose): 2 mg/mL (20 mL); 5 mg/mL (30 mL); 7.5 mg/mL (10 mL, 20 mL); 10 mg/mL (10 mL, 20 mL)

Alahuhta S, Rasanen J, Jouppila P, et al, "The Effects of Epidural Ropivacaine and Bupivacaine for Cesarean Section on Uteroplacental and Fetal Circulation," Anesthesiology, 1995, 83(1):23-32.

Datta S, Camann W, Bader A, et al, "Clinical Effects and Maternal and Fetal Plasma Concentrations of Epidural Ropivacaine Versus Bupivacaine for Cesarean Section," Anesthesiology, 1995, 82(6):1346-52.

McClure JH, "Ropivacaine," Br J Anaesth, 1996, 76(2):300-7.

Scott DB, Lee A, Fagan D, et al, "Acute Toxicity of Ropivacaine Compared With That of Bupivacaine," Anesth Analg, 1989, 69(5):563-9.

Wood MB and Rubin AP, "A Comparison of Epidural 1% Ropivacaine and 0.75% Bupivacaine for Lower Abdominal Gynecologic Surgery," Anesth Analg, 1993, 76(6):1274-8.

Zaric D, Axelsson K, Nydahl P, et al, "Sensory and Motor Blockade During Epidural Analgesia With 1%, 0.75%, and 0.5% Ropivacaine - A Double-Blind Study," Anesth Analg, 1991, 72(4):509-15.