Naropin Dosage/Direction for Use

Naropin should only be used by or under the supervision of clinicians experienced in regional anaesthesia.
Adults and children above 12 years of age: The following table is a guide to dosage for the more commonly used blocks. The clinician's experience and knowledge of the patient's physical status are of importance when deciding the dose.
In general, surgical anaesthesia (e.g. epidural administration) requires the use of the higher concentrations and doses. For analgesia, 2 mg/mL concentration of Naropin is generally recommended. (See Table 2.)

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In order to avoid intravascular injection, aspiration should be repeated prior to and during administration of the main dose, which should be injected slowly or in incremental doses, at a rate of 25-50 mg/min, while closely observing the patient's vital functions and maintaining verbal contact. When an epidural dose is injected, a preceding test dose of 3-5 ml lidocaine (Xylocaine 1-2%) with adrenaline is recommended. An inadvertent intravascular injection may be recognized by a temporary increase in heart rate and an accidental intrathecal injection by signs of a spinal block. If toxic symptoms occur, the injection should be stopped immediately.
In epidural block for surgery, single doses of up to 250 mg ropivacaine have been used and are well-tolerated.
When prolonged epidural blocks are used, either through continuous infusion or through repeated bolus administration, the risks of reaching a toxic plasma concentration or inducing local neural injury must be considered. Cumulative doses up to 800 mg ropivacaine for surgery and postoperative analgesia administered over 24 hours were well-tolerated in adults, as were postoperative continuous epidural infusions at rates up to 28 mg/hr for 72 hours.
For treatment of postoperative pain, the following technique can be recommended: Unless preoperatively instituted, an epidural block with Naropin 7.5 mg/ml is induced via an epidural catheter. Analgesia is maintained with Naropin 2 mg/ml infusion. Clinical studies have demonstrated that infusion rates of 6-14 ml (12-28 mg) per hour provide adequate analgesia with only slight and nonprogressive motor block in most cases of moderate to severe postoperative pain. With this technique, a significant reduction in the need for opioids has been observed.
In clinical studies, an epidural infusion of Naropin 2 mg/ml alone or mixed with fentanyl 1-4 μ/mL has been given for postoperative pain management for up to 72 hours. Naropin 2 mg/mL (6-14 ml/hour) provided adequate pain relief for the majority of patients. The combination of Naropin and fentanyl provided improved pain relief but caused opioid side effects.
For caesarean section, neither intrathecal administration nor the use of the ropivacaine concentration 10 mg/ml for epidural administration, have been documented.
Until further experience has been gained. Naropin cannot be recommended for use in children below the age of 12 years.