Update on ropivacaine

Abstract

Long-acting local anaesthetics are primarily used in the practice of anaesthesia, particularly in regional anaesthesia and analgesia. Ropivacaine is a new long-acting local anaesthetic that has been the focus of interest because of its increased cardiovascular safety compared with bupivacaine. Other advantages of ropivacaine over bupivacaine include a greater sensorimotor differential block and shorter elimination half-life (t(1/2)), with a lower potential for accumulation. The most important attribute of ropivacaine, however, is its increased margin of safety compared with bupivacaine when given in equal doses. Many post-marketing studies have focused on the comparisons of efficacy in blocks and toxicity profiles of bupivacaine versus ropivacaine. Recent animal toxicity studies confirm the results of original studies showing that ropivacaine has less cardiovascular toxicity than bupivacaine with respect to direct myocardial depression, success of resuscitation and arrhythmogenic potential when given in equal doses. Reduced cardiotoxicity may be a distinct characteristic of ropivacaine. A review of current literature suggests that, at clinically relevant doses, ropivacaine provides the lowest potential risk of cardiotoxicity for inadvertent intravascular injection. Studies are currently under way comparing ropivacaine with levobupivacaine, the latest addition to the group of long-acting local anaesthetics.

Initial Development and Characterization of PLGA Nanospheres Containing Ropivacaine

“…They present a comparable clinical efficacy when compared as to latency, potency, and duration of action. However, the main features attributed to this new LA are that RVC provides a lower cardiac toxicity and allows an earlier motor blockade recovery in relation to bupivacaine [3][4][5]. Nowadays, there is a strong clinical requirement for controlled-release local anesthetics, as well as for LA molecules with low systemic uptake that could lead to less toxic side effects [6,7].…”

Pharmacotherapy for Acute Pain: Implications for Practice

“…Ropivacaine, a newer, long-acting local anesthetic, has advantages over bupivacaine because its selective sensory effects reduce motor impairment, increased cardiovascular safety, and shorter elimination half-life (t 1/2 ) with a lower potential for accumulation. 29 Sympatholytic effects of local anesthetics secondary to blockade of the sympathetic chain result in serious consequences if the block reaches the cardiac outflow between T1 and T4. Significant hypotensive and bradycardic responses can result, particularly in the presence of hypovolemia.…”

Postoperative pain management in obstetric anesthesia–new challenges and solutions

“…74,75 At clinically relevant doses, ropivacaine provides the lowest potential risk of cardiotoxicity for inadvertent intravascular injection. 76 Another relatively new local anesthetic currently being investigated is levobupivacaine. When used intrathecally and epidurally for labor analgesia, levobupivacaine had the same clinical efficacy as racemic bupivacaine, but at equal doses it produced less motor block and cardiovascular effect.…”