ropivacaine
TRANSCRIPT
ROPIVACAINEVerdah SabihHouse officerAnesthesiology dept. HFH
INTRODUCTION: Long acting amide local anesthetic with both
anesthetic and analgesic effects. Similar to bupivacaine & etidocaine in
duration of activity. Structurally similar to mapivacaine &
bupivacaine. Decreased cardiotoxicity Used for regional nerve block. At high doses it produces surgical anesthesia
and at lower doses it produces analgesia (sensory block) with limited motor block..
STRUCTURE: belongs to the group of
local anaesthetics, the pipecoloxylidides and has a propyl group on the piperidine nitrogen atom (compared to bupivacaine, which has a butyl group)
Enantiomer of propivacaine (S stereoisomer)
PHARMACOKINETICS Onset time : 15 mins Duration :2-6 hrs Bioavailability:87%–98% (epidural) Metabolism: Hepatic (CYP1A2-mediated) Biological half-life:1.6–6 hours (varies with
administration route) Excretion: Renal 86% less lipophilic than bupivacaine less likely to
penetrate large myelinated motor fibres selective action on the pain-transmitting A β and C nerves rather than Aβ fibres, which are involved in motor function.
bound to plasma proteins to an extent of 94%, mainly to α1-acid glycoprotein.
MODE OF ACTION reversible inhibition of sodium ion influx, and
thereby blocks impulse conduction in nerve fibre.
potentiated by dose-dependent inhibition of potassium channels.
DOSAGE AND ADMINISTRATION Max.dose= 3mg/kg
TECHNIQUES: Epidural block Spinal block Infiltration anesthesia Peripheral nerve block
INDICATIONS Local Surgical anesthesia C-section Hip or lower limb surgery Peripheral nerve blocks Post operative pain management Labour pain management Chronic pain management
CONTRAINDICATIONS Use as intravenous regional anaesthesia
(IVRA).
CLINICAL SIDE EFFECTS CNS toxicity:usually occur at lower blood
plasma concentrations CNS excitation,(nervousness, tingling around
the mouth, tinnitus,tremor, dizziness, blurred vision, seizures) followed by depression(drowsiness, loss of consciousness), respiratory depression and apnea).
CVS toxicity: hypotension, bradycardia, arrhythmias,
and/or cardiac arrest
INTERACTIONS WITH OTHER DRUGS Anti-arrhythmics: increased myocardial
depresssion Antidepressants:meabolism of ropivacaine
inhibited by fluvoxamine(strong inhibitors of cytochrome P4501A2).
other local anaesthetics or agents : (structurally related to amide-type local anaesthetics)toxic effects of these drugs are additive.
TREATMENT OF OVERDOSE: Celepid, a commonly available
intravenouslipid emulsion, can be effective in treating severe cardiotoxicity.