Drug reference

Ropivacaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1449, 1450

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Acute pain, peripheral nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: 10–20 mg/hour, dose administered as a continuous infusion or by intermittent injection using a 2 mg/mL (0.2%) solution Acute pain, field block ▶BY REGIONAL ADMINISTRATION ▶Adult: 2–200 mg, dose administered using a 2 mg/mL continued → (0.2%) solution Acute pain, lumbar epidural block ▶BY LUMBAR EPIDURAL ▶Adult: 20–40 mg, followed by 20–30 mg at least every 30 minutes, dose administered using a 2 mg/mL (0.2%) solution Acute labour pain ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 12–20 mg/hour, dose administered using a 2 mg/mL (0.2%) solution Acute postoperative pain ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: Up to 28 mg/hour, dose administered using a 2 mg/mL (0.2%) solution Postoperative pain, thoracic epidural block ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 12–28 mg/hour, dose administered using a 2 mg/mL (0.2%) solution Surgical anaesthesia, field block ▶BY REGIONAL ADMINISTRATION ▶Adult: 7.5–225 mg, dose administered using a 7.5 mg/mL (0.75%) solution Anaesthesia Surgical anaesthesia, major nerve block (brachial plexus block) ▶BY REGIONAL ADMINISTRATION ▶Adult: 225–300 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia, thoracic epidural block (to establish block for postoperative pain) ▶BY THORACIC EPIDURAL ▶Adult: 38–113 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia for caesarean section ▶BY LUMBAR EPIDURAL ▶Adult: 113–150 mg, to be administered in incremental doses using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia, lumbar epidural block ▶BY LUMBAR EPIDURAL ▶Adult: 113–200 mg, dose administered using a 7.5 mg/mL (0.75%) or 10 mg/mL (1%) solution DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose may need to be calculated on the basis of ideal bodyweight.

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Contra Indications

Avoid injection into infected tissues . avoid injection into inﬂamed tissues. intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises local anaesthetics should not be injected into inﬂamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

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Cautions

Acute porphyrias p. 1120. cardiovascular disease. complete heart block. debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy. hypovolaemia. impaired cardiac conduction. impaired respiratory function. myasthenia gravis. shock

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Allergy And Cross Sensitivity

▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

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Safety

Important Safety Information

Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

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Interactions

→Appendix 1: anaesthetics, local

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Side Effects

▶Common or very common Arrhythmias. back pain. chills. dizziness. headache. hypertension. hypotension. nausea . sensation abnormal. urinary retention. vomiting ▶Uncommon Anxiety. dyspnoea. hypothermia. neurotoxicity. syncope ▶Rare or very rare Cardiac arrest ▶Frequency not known Dyskinesia SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.

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Pregnancy

Not known to be harmful. Do not use for paracervical block in obstetrics.

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Breast Feeding

Not known to be harmful.

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Hepatic Impairment

Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises consider dose reduction for repeat doses in severe impairment.

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Renal Impairment

Caution in severe impairment. Increased risk of systemic toxicity in chronic renal failure.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ELECTROLYTES: May contain Sodium ▶Ropivacaine hydrochloride (Non-proprietary) Ropivacaine hydrochloride 2 mg per 1 ml Ropivacaine 20mg/10ml solution for injection ampoules | 10 ampoule P £16.50–£27.84 (Hospital only) Ropivacaine hydrochloride 7.5 mg per 1 ml Ropivacaine 75mg/10ml solution for injection ampoules | 10 ampoule P £25.00–£28.40 (Hospital only) Ropivacaine hydrochloride 10 mg per 1 ml Ropivacaine 100mg/10ml solution for injection ampoules | 10 ampoule P £30.00–£31.74 (Hospital only) ▶Naropin (Aspen Pharma Trading Ltd) Ropivacaine hydrochloride 2 mg per 1 ml Naropin 20mg/10ml solution for injection ampoules | 5 ampoule P £12.79 Ropivacaine hydrochloride 7.5 mg per 1 ml Naropin 75mg/10ml solution for injection ampoules | 5 ampoule P £15.90 (Hospital only) Ropivacaine hydrochloride 10 mg per 1 ml Naropin 100mg/10ml solution for injection ampoules | 5 ampoule P £19.22 (Hospital only) Infusion ELECTROLYTES: May contain Sodium ▶Ropivacaine hydrochloride (Non-proprietary) Ropivacaine hydrochloride 2 mg per 1 ml Ropivacaine 400mg/200ml infusion bags | 5 bag P £79.35–£82.05 (Hospital only) | 10 bag P £137.00 (Hospital only) ▶Naropin (Aspen Pharma Trading Ltd) Ropivacaine hydrochloride 2 mg per 1 ml Naropin 400mg/200ml infusion Polybags | 5 bag P £86.70 (Hospital only)

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Dose text by age group

Adult

10–20 mg/hour, dose administered as a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2–200 mg, dose administered using a 2 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

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Adult

20–40 mg, followed by 20–30 mg at least every

First-line fragment. Read the complete Indications and Dose section above.

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Adult

12–20 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Up to 28 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

12–28 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

7.5–225 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

225–300 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

38–113 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

113–150 mg, to be administered in incremental

First-line fragment. Read the complete Indications and Dose section above.

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Adult

113–200 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Ropivacaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1449, 1450

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 1449, 1450

Contra Indications

PDF page 1450

Cautions

PDF page 1450

Allergy And Cross Sensitivity

PDF page 1450

Safety

Important Safety Information

PDF page 1450

Interactions

→Appendix 1: anaesthetics, local

PDF page 1450

Side Effects

PDF page 1450

Pregnancy

Not known to be harmful. Do not use for paracervical block in obstetrics.

PDF page 1450

Breast Feeding

Not known to be harmful.

PDF page 1450

Hepatic Impairment

Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises consider dose reduction for repeat doses in severe impairment.

PDF page 1450

Renal Impairment

Caution in severe impairment. Increased risk of systemic toxicity in chronic renal failure.

PDF page 1450

Dose and formulations

Medicinal Forms

PDF page 1450

Dose text by age group

Adult

10–20 mg/hour, dose administered as a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1449

Adult

2–200 mg, dose administered using a 2 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1449

Adult

20–40 mg, followed by 20–30 mg at least every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

12–20 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

Up to 28 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

12–28 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

7.5–225 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

225–300 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

38–113 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

113–150 mg, to be administered in incremental

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Adult

113–200 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1450

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.