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a local anesthetic used as the hydrochloride salt for percutaneous infiltration anesthesia, peripheral nerve block, and epidural block.
ropivacaine/ro·pi·va·caine/ (-piv´ah-kān) a local anesthetic of the amide type, used as the hydrochloride salt for percutaneous infiltration anesthesia, peripheral nerve block, and epidural block.
a local anesthetic.
indications It is used to produce peripheral nerve block, caudal anesthesia, central neural block, and vaginal block.
contraindications Its use is prohibited in children less than 12 years of age, the elderly, those with severe liver disease, and those with known hypersensitivity to this drug.
adverse effects Life-threatening effects are convulsions, loss of consciousness, myocardial depression, cardiac arrest, arrhythmias, fetal bradycardia, status asthmaticus, respiratory arrest, and anaphylaxis. Other adverse effects are anxiety, restlessness, drowsiness, disorientation, tremors, shivering, bradycardia, hypotension, hypertension, nausea, vomiting, blurred vision, tinnitus, pupil constriction, rash, urticaria, allergic reactions, edema, burning, skin discoloration at the injection site, and tissue necrosis.
ropivacaineNaropin® Anesthesiology A local anesthetic, which is less potent and less toxic than bupivacaine. Cf Bupivacaine.
ropivacaineAn aminoamide local anaesthetic drug similar to BUPIVACAINE but with a less toxic effect on the heart and a reduced tendency to block the function of motor nerves. A brand name is Naropin.
ropivacaine; Naropin local anaesthetic agent of long duration of action; has same range of cautions, interactions and contraindications as lidocaine (lignocaine); contraindicated by certain selective serotonin reuptake inhibitor antidepressant agents (see Table 1, Table 2, Table 3 and Table 4)
|Type of local anaesthetic||Onset time||Offset time|
|Lidocaine||5 minutes||30-90 minutes|
|Bupivacaine||20 minutes||6-8 hours|
|Prilocaine||5-10 minutes||2-4 hours|
|Mepivacaine||5-10 minutes||2-4 hours|
|Levo-bupivacaine||20-30 minutes||6-8 hours|
|Ropivacaine||5-10 minutes||2-4 hours|
|Local anaesthetic agent Proprietary name||Principal drug interactions||Effect of interaction|
|Increased myocardial depression|
Increased risk of ventricular arrhythmias if lidocaine is given with quinpristin/dalfopristin
Increased risk of ventricular arrhythmias if lidocaine is given with any drug that prolongs the QT interval of the cardiac cycle
Plasma concentration of lidocaine increased by amprenavir, atazanavir and lopinavir
Increased myocardial depression
Increased risk of lidocaine toxicity when given with propranolol
The action of lidocaine is antagonized by the hypokalaemia caused by acetazolamide, loop diuretics or thiazide and related diuretics (i.e. a greater dose of lidocaine would be required to achieve anaesthesia)
Increased risk of ventricular arrhythmia if lidocaine is given with dolasetron
Plasma concentration of lidocaine increased when given with cimetidine; risk of lidocaine toxicity increased with cimetidine
|Beta-blockers||Increased risk of bupivacaine toxicity when given with propranolol|
Increased risk of myocardial depression if given with other antiarrhythmic agents
|Increased risk of myocardial depression if given with antiarrhythmic agents|
Increased risk of methaemoglobinaemia if given with sulphonamide antibacterial agents
|Antidepressants||Metabolism of ropivacaine is inhibited by fluvoxamine, thereby enhancing the risk of ropivacaine toxicity|
|Drug not listed in the British National Formulary|
|Main presenting complaint||9-year-old girl presents with 3-week history consisting of pain in the medial (tibial) sulcus of the left hallux since 'picking' nail|
Otherwise fit (i.e. no other significant medical history; no regular medications)
Advised to contact you by GP
|Examination||Local tenderness, inflammation and swelling at medial area of left hallux; no signs of obvious infection; medial side of nail plate very ragged as a result of onychotillomania|
Vascular examination: normal
Neurological examination: normal
Dermatological examination: mild hyperhidrosis in both feet
Biomechanical assessment: fully compensated rearfoot varus; no joint pathologies
Social assessment: dance and gymnastics twice a week
Footwear assessment: trainers (one size too small); laces not tied
|Diagnostic tests||None indicated|
|Management plan|| Short-term plan |
Explanation of likely cause of current problem (picking nails, hyperhidrotic skin, short, unlaced shoes, excess pronation)
1. Immediate treatment: exploration of both sides of both first toenails, and reduction of ragged edges with Black's file + LA is necessary, with patient/parental consent. Advise regime of daily warm saline foot baths and demonstration to mother on how to pack affected sulcus with cotton wool. Review in 7 days (or SOS)
Exercise advice: no gym/sport/dance before next appointment
Shoe advice (give leaflet) - needs a larger trainer, and needs to tie laces so that rearfoot is retained in the heel cup of the shoe
Skin care advice (treatment/avoidance of hyperhidrosis) - give leaflet
3. Temporary insole with medial felt (cobra) pad to minimize hallux trauma due to excess compensatory pronation/foot lengthening on weight-bearing
4. Letter to GP informing of action to date (copy to notes)
Explanation of details of other treatments that may be necessary after next visit
1. Further clearance of medial side of first nail or removal of spike of nail under LA or removal of medial section of first nail under LA and phenolization of exposed pocket of nail matrix + dressings (94% cure rate) + details of aftercare regimes for this range of options
2. Biomechanical and gait evaluation, with provision of bespoke antipronatory orthoses
3. Review patient every 4 months to monitor biomechanical, skin and nail function
LA, local anaesthetic.
|Agent (brand name)||Maximum safe dose (70-kg adult)||Dose per kg of body mass|
a long-acting aminoamide local anesthetic agent, similar to bupivacaine.