Version May 2024
Dose varies with procedure, onset and depth of anesthesia desired, vascularity of tissues, duration of anesthesia, and condition of patient. A test dose (eg, 3 to 5 mL) of short-acting local anesthetic containing epinephrine should be administered prior to epidural anesthesia or induction of complete block with ropivacaine. Incremental ropivacaine dosing is recommended. Adults:
Surgical anesthesia:
Lumbar epidural block for surgery:
15 to 30 mL of 0.5% solution
15 to 25 mL of 0.75% solution
15 to 20 mL of 1% solution
Lumbar epidural block for cesarean delivery:
20 to 30 mL dose of 0.5% solution
15 to 20 mL dose of 0.75% solution
Thoracic epidural block:
5 to 15 mL dose of 0.5% solution
5 to 15 mL dose of 0.75% solution
Major nerve block:
35 to 50 mL dose of 0.5% solution
10 to 40 mL dose of 0.75% solution
Field block: 1 to 40 mL dose of 0.5% solution
Labor pain management: Lumbar epidural: Initial: 10 to 20 mL 0.2% solution; continuous infusion dose: 6 to 14 mL/hour of 0.2% solution with intermittent bolus injections of up to 10 to 15 mL/hour of 0.2% solution.
Postoperative pain management:
Peripheral nerve block: Continuous infusion dose: 5 to 10 mL/hour of 0.2% solution (Ref)
Lumbar or thoracic epidural: Continuous infusion dose: 6 to 14 mL/hour of 0.2% solution
Infiltration/minor nerve block:
1 to 100 mL dose of 0.2% solution
1 to 40 mL dose of 0.5% solution
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling. However, ropivacaine and its metabolites are renally excreted, and the risk of toxic reactions may be greater.
There are no dosage adjustments provided in the manufacturer’s labeling. Use with caution; ropivacaine undergoes hepatic metabolism and patients may be at a greater risk for developing toxic drug levels.
Refer to adult dosing. Use with caution; initial dose reductions may be necessary.
(For additional information see "Ropivacaine: Pediatric drug information")
Note: Dose varies with procedure, depth of anesthesia, vascularity of tissues, duration of anesthesia, and condition of patient. Consider incremental administration with negative aspiration prior to each injection; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided (Ref). Should only be administered under the supervision of a qualified physician experienced in the use of anesthetics. Dosing units are variable (mL/kg, mg/kg); use extra precaution to ensure accuracy and minimize potential toxicity.
Central nerve blocks/anesthesia (eg, caudal, lumbar, thoracic): Limited data available:
Caudal block: Infants and Children: Caudal injection: 0.2% (2 mg/mL) solution: 0.5 to 1 mL/kg; some experts suggest a maximum volume of 25 mL (Ref).
Epidural block (eg, lumbar, thoracic): Infants, Children, and Adolescents: Epidural injection 0.2% (2 mg/mL): 0.7 mL/kg. Note: For infants (particularly young infants) if repeat injections necessary, a decreased dose may be necessary to prevent drug accumulation. Some experts suggest if at least 45 minutes since initial dose, reduce dose to 1/3 of the initial or if at least 90 minutes since initial dose, then reduce dose to ½ of the initial. If additional doses are necessary, doses should be reduced to ½ of the previous dose (Ref).
Epidural, continuous infusion:
Infants <3 months: Epidural injection: Bolus: Usual concentration 0.2% (2 mg/mL) solution: Reported range: 0.5 to 1 mL/kg. In some cases, a more dilute solution (eg, 0.1% [1 mg/mL]) may be required to ensure adequate volume and minimize toxicity. Follow with continuous epidural infusion of 0.2% (2 mg/mL) solution at 0.2 mg/kg/hour (Ref).
Infants ≥3 months, Children, and Adolescents: Epidural injection: 0.2% (2 mg/mL) solution: Bolus: Reported range: 0.5 to 1 mL/kg administered over several minutes (eg, 3 to 5 minutes) followed by continuous epidural infusion at 0.2 to 0.5 mg/kg/hour; in trials, 0.4 mg/kg/hour was frequently reported; some suggest a maximum infusion rate of 0.2 mg/kg/hour for infants <6 months of age although higher rates have been reported; in adults, usual rates are 6 to 14 mL/hour of 0.2% solution (Ref).
Peripheral nerve blocks/local anesthesia: Limited data available: Note: Dose varies with location of block (ie, procedure), depth of anesthesia, vascularity of tissues, duration of anesthesia, and patient parameters (eg, age, weight, condition).
Single injection: The volume of dose (mL/kg) and concentration of solution are site-specific based upon anatomy and variable among patients and procedure (Ref).
Infants ≥6 months, Children, and Adolescents: Suggested or reported dose volumes presented; not to exceed a suggested maximum dose of 3 mg/kg/dose based on lean body mass; dosing based on extrapolation from adult experience; additional data necessary to more clearly define the pediatric upper dose limit. Note: For infants <6 months of age, dose reductions (eg, by 30%) have been suggested by experts (Ref).
Commonly accepted doses (Ref):
Head and neck blocks: 0.05 mL/kg.
Maxillary nerve: 0.15 mL/kg (Ref).
Upper extremity blocks:
Brachial plexus: 0.2 to 0.3 mL/kg.
Digital nerve: ≤0.2% (2 mg/mL) solution: 0.05 mL/kg.
Truncal blocks:
Transversus abdominis plane: 0.2 to 0.5 mL/kg (Ref).
Ilioinguinal nerve: 0.075 mL/kg.
Rectus sheath: 0.1 to 0.2 mL/kg.
Lower extremity blocks:
Femoral nerve: 0.2% to 0.5% (2 to 5 mg/mL) solution: 0.2 to 0.4 mL/kg (Ref).
Sciatic nerve: 0.2 to 0.3 mL/kg.
Continuous peripheral nerve block infusion (CPNB): Dosing based on trial experience (Ref):
Infants ≥6 months, Children, and Adolescents:
Initial bolus: 0.2% (2 mg/mL) solution: Dose dependent on nerve catheter location: Commonly reported dose range: ~0.5 to 1.32 mg/kg; some patients and/or catheter/nerve sites may require a higher bolus dose; a trial evaluating 403 pediatric catheter placements reported an overall median bolus for all catheter sites of 1.32 mg/kg (interquartile range [IQR]: 0.82 to 1.95 mg/kg); another trial reporting on 339 pediatric catheter placements reported a mean initial bolus dose of 0.49 to 0.98 mg/kg.
Continuous peripheral nerve block infusion: 0.2% (2 mg/mL) solution: Reported mean rate range: 0.11 to 0.25 mg/kg/hour (most experience reported at 0.2 to 0.25 mg/kg/hour); reported IQR range from 403 pediatric catheter placements: 0.12 to 0.33 mg/kg/hour (depending upon catheter site) with a usual duration <72 hours; the majority of experience is postoperative pain management following orthopedic procedures including administration via On-Q pump or Ambu Smart-Infuser.
Spinal anesthesia: Limited data available: Infant, Children, and Adolescents ≤17 years: Intrathecal (via LP site; L 3-5): Preservative-free 0.5% (5 mg/mL) isobaric solution: 0.5 mg/kg; maximum dose: 20 mg/dose (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling. However, ropivacaine and its metabolites are renally excreted, and the risk of toxic reactions may be greater.
There are no dosage adjustments provided in the manufacturer's labeling. Use with caution; ropivacaine undergoes hepatic metabolism and patients may be at a greater risk for developing toxic drug levels.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Bradycardia (6% to 20%), hypotension (32% to 69%)
Gastrointestinal: Nausea (13% to 25%), vomiting (7% to 12%)
Neuromuscular & skeletal: Back pain (4% to 16%)
1% to 10%:
Cardiovascular: Chest pain (1% to 5%), hypertension (1% to 5%), tachycardia (1% to 5%)
Dermatologic: Pruritus (1% to 5%)
Endocrine & metabolic: Hypokalemia (1% to 5%)
Genitourinary: Disorder of breast milk secretion (1%), oliguria (1% to 5%), poor progression of labor (1%), urinary retention (1% to 5%), urinary tract infection (1% to 5%)
Hematologic & oncologic: Anemia (6%)
Nervous system: Anxiety (1%), chills (≤3%), dizziness (3%), headache (5% to 8%), hypoesthesia (2%), pain (4% to 8%), paresthesia (2% to 6%), rigors (≤3%)
Neuromuscular & skeletal: Muscle cramps (1% to 5%)
Respiratory: Dyspnea (1% to 5%), rhinitis (1%)
Miscellaneous: Fever (2% to 9%)
<1%:
Cardiovascular: Acute myocardial infarction, atrial fibrillation, cardiac arrhythmia, deep vein thrombosis, ECG abnormality, extrasystoles, orthostatic hypotension, phlebitis, pulmonary embolism, ST segment changes on ECG, syncope
Dermatologic: Skin rash, urticaria
Endocrine & metabolic: Hypomagnesemia
Gastrointestinal: Fecal incontinence, tenesmus
Genitourinary: Urinary incontinence, urination disorder, uterine atony
Hepatic: Jaundice
Local: Pain at injection site
Nervous system: Agitation, amnesia, asthenia, coma, confusion, drowsiness, emotional lability, hallucination, Horner syndrome, hypothermia, hypotonia, insomnia, malaise, nervousness, neuropathy, nightmares, paresis, seizure, stupor, tremor, vertigo
Neuromuscular & skeletal: Dyskinesia, hypokinesia, myalgia
Ophthalmic: Blepharoptosis, visual disturbance
Otic: Auditory disturbance, tinnitus
Respiratory: Bronchospasm, cough
Miscellaneous: Accidental injury
Hypersensitivity to ropivacaine, amide-type local anesthetics (eg, bupivacaine, mepivacaine, lidocaine), or any component of the formulation
Canadian labeling: Additional contraindications (not in US labeling): Intravenous regional anesthesia (Bier block); obstetric paracervical block anesthesia
Concerns related to adverse effects:
• CNS toxicity: Careful and constant monitoring of the patient's state of consciousness should be done following each local anesthetic injection; at such times, restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of CNS toxicity. Treatment is primarily symptomatic and supportive.
• Intra-articular infusion related chondrolysis: Continuous intra-articular infusion of local anesthetics after arthroscopic or other surgical procedures is not an approved use; chondrolysis (primarily in the shoulder joint) has occurred following infusion, with some cases requiring arthroplasty or shoulder replacement.
• Methemoglobinemia: Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment along with discontinuation of the anesthetic and other oxidizing agents. Onset may be immediate or delayed (hours) after anesthetic exposure. Patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, exposure to oxidizing agents or their metabolites, or infants <6 months of age are more susceptible and should be closely monitored for signs and symptoms of methemoglobinemia (eg, cyanosis, headache, rapid pulse, shortness of breath, lightheadedness, fatigue).
• Respiratory arrest: Local anesthetics have been associated with rare occurrences of sudden respiratory arrest.
• Seizures: Convulsions due to systemic toxicity leading to cardiac arrest have also been reported, presumably following unintentional intravascular injection.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with hypotension, hypovolemia, heart block, or cardiovascular disease; may be at greater risk for toxicity.
• Hepatic impairment: Use with caution in patients with hepatic impairment; may be at greater risk for toxicity.
• Neurological disorders: Use with caution in patients with neurological disorders; may be at greater risk for toxicity.
• Porphyria: Use with caution in patients with acute porphyria; consider use of alternative agents.
• Psychiatric disorders: Use with caution in patients with psychiatric disorders; may be at greater risk for toxicity.
• Renal impairment: Use with caution in patients with severe renal impairment; may be at greater risk for toxicity.
Special populations:
• Acutely ill patients: Use with caution in acutely ill; may be at greater risk for toxicity.
• Debilitated patients: Use with caution in debilitated patient; may be at greater risk for toxicity.
• Older adult: Use with caution in the elderly: may be at greater risk for toxicity. Cardiovascular adverse events (bradycardia, hypotension) may be age-related (more common in patients >61 years of age).
Other warnings/precautions:
• Administration: Intravascular injections should be avoided; aspiration should be performed prior to administration; the needle must be repositioned until no return of blood can be elicited by aspiration; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided.
• Trained personnel: Clinicians using local anesthetic agents should be well trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection, as hydrochloride [preservative free]:
Naropin: 2 mg/mL (10 mL, 20 mL, 100 mL, 200 mL); 5 mg/mL (20 mL, 30 mL, 200 mL); 7.5 mg/mL (20 mL); 10 mg/mL (10 mL, 20 mL)
Generic: 2 mg/mL (10 mL, 20 mL, 100 mL, 200 mL); 5 mg/mL (20 mL, 30 mL, 100 mL, 200 mL); 7.5 mg/mL (20 mL); 10 mg/mL (10 mL, 20 mL)
Yes
Solution (Naropin Injection)
2 mg/mL (per mL): $0.46
5 mg/mL (per mL): $0.25
7.5 mg/mL (per mL): $1.13
10 mg/mL (per mL): $1.36
Solution (ROPivacaine HCl Injection)
2 mg/mL (per mL): $0.30 - $0.81
5 mg/mL (per mL): $0.16 - $1.26
7.5 mg/mL (per mL): $1.62
10 mg/mL (per mL): $0.60 - $1.98
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection, as hydrochloride:
Naropin: 2 mg/mL (100 mL, 200 mL); 5 mg/mL (20 mL); 10 mg/mL (10 mL, 20 mL)
Generic: 2 mg/mL (10 mL, 20 mL, 100 mL, 200 mL); 5 mg/mL (10 mL); 10 mg/mL (10 mL, 20 mL)
Administered via local infiltration, epidural block and epidural infusion, or intermittent bolus. Avoid rapid administration of large volumes of ropivacaine; use fractional (incremental) doses with the lowest effective dose and concentration required to produce the desired result. Prior to epidural anesthesia or induction of complete block, a test dose (eg, 3 to 5 mL) of short-acting local anesthetic with epinephrine should be administered. The On-Q infusion pump is used to slowly administer local anesthetics (eg, bupivacaine, lidocaine, ropivacaine) to or around surgical wound sites and/or in close proximity to nerves for pre- or postoperative regional anesthesia. When infused directly into the shoulder, destruction of articular cartilage (chondrolysis) has occurred. On-Q pumps should never be placed directly into any joint (Ref).
Parenteral: Administered via local infiltration, epidural block and epidural infusion, or intermittent bolus; if further dilution necessary, ensure appropriate diluent (eg, preservative-free). Prior to ropivacaine administration as epidural anesthesia or induction of complete block, a test dose of short acting local anesthetic with epinephrine should be administered to verify avoidance of intravascular site. Incremental ropivacaine dosing is recommended. Do not administer large volume of anesthetic rapidly. Various infusion pumps are on market and used to slowly administer local anesthetics (eg, bupivacaine, lidocaine, ropivacaine) to or around surgical wound sites and/or in close proximity to nerves for pre- or postoperative regional anesthesia; in most pediatric trials, an On-Q pump was used. When infused directly into the shoulder, destruction of articular cartilage (chondrolysis) has occurred. On-Q pumps should never be placed directly into any joint (see https://www.ismp.org/Newsletters/acutecare/archives/May09.asp).
Acute pain management: For acute pain management administered as an epidural continuous infusion, intermittent bolus (eg, postoperative or labor), or local infiltration.
Surgical anesthesia: For the production of local or regional anesthesia for surgery administered as an epidural block, including cesarean delivery, major nerve block, or local infiltration.
ROPivacaine may be confused with BUPivacaine, rOPINIRole
Infusion bottles of Naropin (ropivacaine) and Ofirmev (acetaminophen) look similar. Potentially fatal mix-ups have been reported in which a glass bottle of Naropin was mistaken for Ofirmev in perioperative areas.
The Institute for Safe Medication Practices (ISMP) includes this medication (epidural administration) among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Substrate of CYP1A2 (major), CYP2B6 (minor), CYP2D6 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
BUPivacaine: Local Anesthetics may enhance the adverse/toxic effect of BUPivacaine. Management: Avoid using any additional local anesthetics within 96 hours after insertion of the bupivacaine implant (Xaracoll) or bupivacaine and meloxicam periarticular solution (Zynrelef) or within 168 hours after subacromial infiltration (Posimir brand). Risk C: Monitor therapy
BUPivacaine (Liposomal): Local Anesthetics may enhance the adverse/toxic effect of BUPivacaine (Liposomal). Management: Liposomal bupivacaine should not be administered with local anesthetics, but may be administered 20 minutes or more after lidocaine. Avoid all local anesthetics within 96 hours after administration of liposomal bupivacaine. Risk X: Avoid combination
CYP1A2 Inhibitors (Moderate): May increase the serum concentration of ROPivacaine. Risk C: Monitor therapy
CYP1A2 Inhibitors (Strong): May increase the serum concentration of ROPivacaine. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hyaluronidase: May enhance the adverse/toxic effect of Local Anesthetics. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Neuromuscular-Blocking Agents: Local Anesthetics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Technetium Tc 99m Tilmanocept: Local Anesthetics may diminish the diagnostic effect of Technetium Tc 99m Tilmanocept. Management: Avoid mixing and simultaneously co-injecting technetium Tc 99m tilmanocept with local anesthetics. This interaction does not appear to apply to other uses of these agents in combination. Risk C: Monitor therapy
Ropivacaine crosses the placenta following epidural administration (Matsota 2009; Simpson 2005).
Ropivacaine may potentially cause varying degrees of maternal, fetal, and neonatal toxicity involving the CNS, peripheral vascular tone, and cardiac function depending on dose and administration technique.
Ropivacaine is approved for use in obstetric analgesia/anesthesia (ACOG 2019; Reschke 2020).
Ropivacaine is present in breast milk.
Data related to the presence of ropivacaine in breast milk are available from a study of 25 patients administered ropivacaine 0.15% combined with fentanyl for patient-controlled epidural analgesia following elective cesarean delivery. The mean (± SD) accumulated doses of ropivacaine following epidural administration were 187.7 ± 53.9 mg and 248.3 ± 61.8 mg, at 18 and 24 hours, respectively. Corresponding maternal plasma concentrations were 979 ± 263 ng/mL (18 hours), and 1,282 ± 261 ng/mL (24 hours). Breast milk concentrations of ropivacaine were 246 ± 98 ng/mL at 18 hours and 301 ± 122 ng/mL at 24 hours. Adverse events were not observed in the patients or breastfed neonates (Matsota 2009).
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother; however, local anesthetics are considered compatible with breastfeeding (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Mitchell 2020).
Heart rate, blood pressure, ECG monitoring (if used with antiarrhythmics)
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 action: Anesthesia (route dependent): 3 to 15 minutes
Duration (dose and route dependent): 3 to 15 hours
Protein binding: 94%, primarily to alpha1-acid glycoprotein
Distribution: Vd:
Children: Epidural infusion: 2.1 to 4.2 L/kg (Hansen 2000)
Adults: Intravascular infusion: 41 ± 7 L
Metabolism: Hepatic, via CYP1A2 to metabolites
Half-life elimination:
Children: Epidural: Terminal phase: 4.9 hours (range: 3 to 6.7 hours) (Hansen 2000)
Adults: Epidural: 5 to 7 hours; IV: Terminal: 111 ± 62 minutes (Lee, 1989)
Time to peak, serum: Dose and route dependent: Caudal:
Infants: Median: 60 minutes (range: 15 to 90 minutes) (Wulf 2000)
Children: Mean: 60 minutes (range: 12 to 249 minutes (Lonnqvist 2000)
Excretion: Urine (86%; 1% as unchanged drug)
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