Adult: Lumbar epidural block, particularly for labour pain: As 0.2% solution: 20-40 mg (10-20 mL) initial bolus inj, followed by 20-30 mg (10-15 mL) intermittent inj at intervals of at least 30 minutes. Alternatively, 12-20 mg/hour (6-10 mL/hour) via continuous epidural infusion may be given. Lumbar or thoracic epidural block for postoperative pain management: As 0.2% solution: 12-28 mg/hour (6-14 mL/hour) via continuous epidural infusion. Field block, particularly minor nerve block and infiltration: As 0.2% solution: 2-200 mg (1-100 mL). As 0.5% solution: 5-200 mg (1-40 mL). Peripheral nerve block: As 0.2% solution: 10-20 mg/hour (5-10 mL/hour) via continuous infusion or intermittent inj. Individualise dosage based on the inj site, procedure and patient status. Administer a test dose of lidocaine with epinephrine before epidural anaesthesia or when large doses are to be given. Administer doses slowly and incrementally; use the lowest effective dose and concentration to produce the desired effect. Recommendations may vary among individual products or between countries (refer to specific product or local guidelines). Elderly: Dose reduction may be needed. Child: Dosage recommendations may vary according to age, procedure and physical status of patient (refer to local or specific product guidelines).
Parenteral Surgical anaesthesia
Adult: Lumbar epidural block for surgery: As 0.5% solution: 75-150 mg (15-30 mL). As 0.75% solution: 113-188 mg (15-25 mL). As 1% solution: 150-200 mg (15-20 mL). Lumbar epidural block for caesarean section: As 0.5% solution: 100-150 mg (20-30 mL). As 0.75% solution: 113-150 mg (15-20 mL). Thoracic epidural block to establish a block for postoperative pain: As 0.5% solution: 25-75 mg (5-15 mL). As 0.75% solution: 38-113 mg (5-15 mL), depending on the inj level. Major nerve block, particularly brachial plexus block: As 0.5% solution: 175-250 mg (35-50 mL). As 0.75% solution: 225-300 mg (30-40 mL). Field block, particularly minor nerve block and infiltration: As 0.5% solution: 5-200 mg (1-40 mL). As 0.75% solution: 7.5-225 mg (1-30 mL). Individualise dosage based on the inj site, procedure and patient status. Administer a test dose of lidocaine with epinephrine before epidural anaesthesia or when large doses are to be given. Administer doses slowly and incrementally; use the lowest effective dose and concentration to produce the desired effect. Recommendations may vary among individual products or between countries (refer to specific product or local guidelines). Elderly: Dose reduction may be needed.
What are the brands available for Ropivacaine in Malaysia?
Severe: Dose reduction may be needed for repeated doses.
Incompatibility
May result in precipitation if mixed with alkaline solutions.
Contraindications
Hypersensitivity to ropivacaine or other amide-type local anaesthetics. Should not be used for IV regional anaesthesia (Bier's block) and obstetric paracervical block.
Special Precautions
Patient with hypovolaemia, CV disease (e.g. hypotension, partial or complete heart block), neurological or psychiatric disorders, myasthenia gravis, acute porphyria; risk factors for methaemoglobinaemia (e.g. G6PD deficiency, congenital or idiopathic methaemoglobinaemia, cardiac or pulmonary compromise). Acutely ill or debilitated patients. Avoid intravascular inj, rapid administration of large doses, or inj into inflamed or infected areas. Not approved for use as continuous intra-articular infusion after arthroscopic or other surgical procedures. Hepatic and severe renal impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS toxicity (e.g. dizziness, drowsiness, blurred vision, tinnitus, restlessness, anxiety, depression, tremor); hypotension, bradycardia; methaemoglobinaemia; chondrolysis, particularly in the shoulder joint (if given via continuous intra-articular infusion). Cardiac disorders: Tachycardia. Gastrointestinal disorders: Nausea, vomiting. General disorders and administration site conditions: Chills, fever, pain. Immune system disorders: Rarely, allergic reactions. Musculoskeletal and connective tissue disorders: Back pain. Nervous system disorders: Headache, paraesthesia, hypoaesthesia. Psychiatric disorders: Anxiety. Renal and urinary disorders: Urinary retention. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Pruritus. Vascular disorders: Hypertension. Potentially Fatal: Convulsions which may lead to cardiac arrest (if accidentally given via intravascular inj). Rarely, sudden respiratory arrest.
Monitoring Parameters
Monitor blood pressure, heart rate and ECG (particularly if used with antiarrhythmic agents). Closely monitor the patient's vital functions, including for signs of CV or CNS toxicity after each inj (especially for epidural administration). Assess for signs and symptoms of methaemoglobinaemia (particularly in patients at risk).
Overdosage
Symptoms: Hearing or visual disturbances, dizziness, lightheadedness, perioral numbness, paraesthesia, dysarthria, muscle rigidity or twitching, and convulsions. Hypotension, bradycardia and arrhythmia may occur in severe cases.
Management: Symptomatic and supportive treatment. For CNS depression and convulsions, provide appropriate airway or respiratory support and give anticonvulsants. Administer appropriate IV fluids, vasopressor and/or inotropic agents if CV depression occurs. In case of circulatory arrest, institute cardiopulmonary resuscitation immediately; maintain optimal oxygenation and ventilation, and treat acidosis.
Drug Interactions
May potentiate systemic adverse effects with other local anaesthetics, agents structurally similar to amide-type local anaesthetics (e.g. lidocaine, mexiletine), general anaesthetics or opioids. May result in additive cardiac effects with class III antiarrhythmics (e.g. amiodarone). May reduce clearance which may lead to increased serum levels with strong CYP1A2 inhibitors (e.g. fluvoxamine, enoxacin). May increase the risk of methaemoglobinaemia with glyceryl trinitrate, cyclophosphamide, flutamide, chloroquine, dapsone, phenytoin, and quinine.
Action
Description: Mechanism of Action: Ropivacaine, a long-acting amide-type local anaesthetic, produces anaesthetic effects at high doses and analgesic properties at lower doses. It inhibits both the initiation and conduction of nerve impulses by reducing the permeability of neuronal membranes to sodium ions, leading to the prevention of depolarisation with resultant blockade of conduction. Onset: 3-15 minutes (depending on the route and dose). Duration: 3-15 hours (depending on the route and dose). Pharmacokinetics: Distribution: Crosses the placenta and enters breast milk. Plasma protein binding: Approx 94%, mainly to α1-acid glycoprotein. Metabolism: Extensively metabolised in the liver via aromatic hydroxylation by CYP1A2 isoenzyme to form 3-hydroxy-ropivacaine. Excretion: Via urine (86%; 1% as unchanged drug). Elimination half-life: 5-7 hours (epidural).
Chemical Structure
Ropivacaine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 175805, Ropivacaine. https://pubchem.ncbi.nlm.nih.gov/compound/Ropivacaine. Accessed Sept. 26, 2025.
Storage
Store between 15-30°C. Do not refrigerate or freeze.
N01BB09 - ropivacaine ; Belongs to the class of amides. Used as local anesthetics.
References
Brayfield A, Cadart C (eds). Ropivacaine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/08/2025.Fresenius Kabi New Zealand Limited. Ropivacaine Kabi 0.2% (2.0 mg/mL), 0.5% (5.0 mg/mL), 0.75% (7.5 mg/mL) and 1% (10 mg/mL) Solution for Injection data sheet 20 Sep 2024. Medsafe. http://www.medsafe.govt.nz. Accessed 01/08/2025.Joint Formulary Committee. Ropivacaine Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/08/2025.Naropin 2 mg/mL and 7.5 mg/mL Solution for Injection/Infusion (Aspen Medical Products Malaysia Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 01/08/2025.Naropin Injection, Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/08/2025.Ropivacaine 2 mg/mL Solution for Injection (Fresenius Kabi Limited). MHRA. https://products.mhra.gov.uk. Accessed 01/08/2025.Ropivacaine 7.5 mg/mL Solution for Injection (Sintetica GmbH). MHRA. https://products.mhra.gov.uk. Accessed 01/08/2025.Ropivacaine Hydrochloride. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 01/08/2025.Ropivacaine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 01/08/2025.
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