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Systematic (IUPAC) name
CAS number 84057-95-4
ATC code N01BB09
PubChem 175805
DrugBank APRD00492
Chemical data
Formula C17H26N2O 
Mol. mass 274.4 g/mol
Pharmacokinetic data
Bioavailability 87%–98% (epidural)
Metabolism Hepatic (CYP1A2-mediated)
Half life 1.6–6 hours (varies with administration route)
Excretion Renal 86%
Therapeutic considerations
Pregnancy cat.


Legal status

Prescription Only (S4)(AU)

Routes Parenteral

Ropivacaine (rINN) (pronounced /roʊˈpɪvəkeɪn/) is a local anaesthetic drug belonging to the amino amide group. The name ropivacaine refers to both the racemate and the marketed S-enantiomer. Ropivacaine hydrochloride is commonly marketed by AstraZeneca under the trade name Naropin.



Ropivacaine was developed after bupivacaine was noted to be associated with cardiac arrest in 0.5–0.75% of cases, particularly in pregnant women. Ropivacaine was found to have less cardiotoxicity than bupivacaine in animal models.

Clinical use


Ropivacaine is indicated for local anaesthesia including infiltration, nerve block, epidural and intrathecal anaesthesia in adults and children over 12 years. It is also indicated for peripheral nerve block and caudal epidural in children 1–12 years for surgical pain. It is also sometimes used for infiltration anaesthesia for surgical pain in children.

Ropivacaine is often co-administered with fentanyl for epidural analgesia, for example in pregnant women during labour.


Ropivacaine is contraindicated for IV regional anaesthesia (IVRA).

Adverse effects

Adverse drug reactions (ADRs) are rare when it is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia, however allergic reactions can rarely occur.

Systemic exposure to excessive quantities of ropivacaine mainly result in central nervous system (CNS) and cardiovascular effects – CNS effects usually occur at lower blood plasma concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures) followed by depression (drowsiness, loss of consciousness, respiratory depression and apnea). Cardiovascular effects include hypotension, bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.[1]

Treatment of overdose: "Lipid rescue"

As for bupivacaine, there is evidence that Intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose in animal experiments[2] and in humans.[3][4][5]


  1. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
  2. ^ Weinberg, G, Ripper, R, Feinstein, DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003;28:198-202. PMID 12772136
  3. ^ Picard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9. PMID 16430560
  4. ^ Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8. PMID 16810015
  5. ^ Litz, RJ, Popp M, Stehr S N, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006;61:800-1.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Ropivacaine". A list of authors is available in Wikipedia.
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