Naropin

ropivacaine

(roe-pi-vi-kane) ,

Naropin

(trade name)

Classification

Therapeutic: epidural local anesthetics
Pregnancy Category: B

Indications

Local or regional anesthesia for surgery.Acute pain management.

Action

Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.

Therapeutic effects

Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Pharmacokinetics

Absorption: Systemic absorption follows epidural administration, but amount absorbed depends on dose.
Distribution: If systemic absorption occurs, this agent is widely distributed and crosses the placenta.
Metabolism and Excretion: Small amounts that may reach systemic circulation are mostly metabolized by the liver; < 1% excreted unchanged in the urine.
Half-life: 4.2 hr (after epidural use).

Time/action profile (analgesia)

ROUTEONSETPEAKDURATION
Epidural10–30 minunknown2–8 hr†
†Duration of anesthetic block

Contraindications/Precautions

Contraindicated in: Hypersensitivity; cross-sensitivity with other amide local anesthetics may occur (bupivacaine, lidocaine, mepivacaine, prilocaine).
Use Cautiously in: Concurrent use of other local anesthetics; Liver disease; Concurrent use of anticoagulants (including low-dose heparin and low-molecular-weight heparins/heparinoids) ↑ the risk of spinal/epidural hematomas; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • anxiety
  • dizziness
  • headache
  • rigors

Cardiovascular

  • cardiovascular collapse (life-threatening)
  • arrhythmias
  • bradycardia
  • chest pain
  • hypertension
  • hypotension (most frequent)
  • tachycardia

Gastrointestinal

  • nausea
  • vomiting

Genitourinary

  • urinary retention

Dermatologic

  • pruritus

Fluid and Electrolyte

  • hypokalemia
  • metabolic acidosis

Hematologic

  • anemia

Neurologic

  • circumoral tingling/numbness
  • paresthesia

Respiratory

  • dyspnea

Musculoskeletal

  • chondrolysis

Miscellaneous

  • allergic reactions
  • fever

Interactions

Drug-Drug interaction

Additive toxicity may occur with concurrent use of other amide localanesthetics (includinglidocaine, mepivacaine, and prilocaine ).Fluvoxamine, amiodarone, ciprofloxacin, and propofol may ↑ the effects of ropivacaine.

Route/Dosage

Surgical Anesthesia
Epidural (Adults) Lumbar epidural—15–30 mL of 0.5% solution or 15–25 mL of 0.75% solution or 15–20 mL of 1% solution; Lumbar epidural for cesarean section—20–30 mL of 0.5% solution or 15–20 mL of 0.75% solution; Thoracic epidural—5–15 mL of 0.5–0.75% solution.
Major nerve block: (Adults) 35–50 mL of 0.5% solution or 10–40 mL of 0.75% solution.
Field block: (Adults) 1–40 mL of 0.5% solution.
Labor Pain
Epidural (Adults) Lumbar epidural—10–20 mL of 0.2% solution initially, then continuous infusion of 6–14 mL/hr of 0.2% solution with incremental injection of 10–15 mL/hr of 0.2% solution.
Postoperative Pain
Epidural (Adults) Lumbar or thoracic epidural—Continuous infusion of 6–14 mL/hr of 0.2% solution.
Infiltration (minor nerve block): (Adults) 1–100 mL of 0.2% solution or 1–40 mL of 0.5% solution.

Availability (generic available)

Solution for injection (preservative-free): 0.2%, 0.5%, 0.75%, 1%

Nursing implications

Nursing assessment

  • Monitor for sensation during procedure and return of sensation after procedure.
  • Systemic Toxicity: Assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, cardiac dysrhythmias). Report to anesthesiologist.
  • Orthostatic Hypotension: Monitor BP, heart rate, and respiratory rate continuously while patient is receiving this medication. Mild hypotension is common because of the effect of local anesthetic block of nerve fibers on the sympathetic nervous system, causing vasodilation. Significant hypotension and bradycardia may occur, especially when rising from a prone position or following large dose increases or boluses. Treatment of unresolved hypotension may include hydration, decreasing the epidural infusion rate, and/or removal of local anesthetic from analgesic solution.
  • Unwanted Motor and Sensory Deficit: Low-dose local anesthetics are added to epidural opioids for pain management to provide analgesia, not to produce anesthesia. Patients should be able to ambulate if their condition allows; epidural analgesic should not hamper ambulation. Location of epidural catheter, local anesthetic dose, and variability in patient response, can result in unwanted motor and sensory deficits. Pain is the first sensation lost, followed by temperature, touch, proprioception, and skeletal muscle tone.
    • Assess for sensory deficit every shift. Ask patient to point to numb and tingling skin areas (numbness and tingling at the incision site is common and usually normal). Notify health care professional of unwanted motor and sensory deficits.
    • Unwanted motor and sensory deficits often can be corrected;a change in position may relieve temporary sensory loss in an extremity, minor extremity muscle weakness is often treated by decreasing the epidural infusion rate and keeping the patient in bed until the weakness resolves. Sometimes removing local anesthetic from the analgesic solution is necessary, such as when signs of local anesthetic toxicity are detected or when treatment of motor and sensory deficits has been unsuccessful.

Potential Nursing Diagnoses

Acute pain, acute (Indications)
Impaired physical mobility

Implementation

  • See Route and Dosage section.

Patient/Family Teaching

  • Instruct patient to notify nurse if signs or symptoms of systemic toxicity occur.
  • Advise patient to request assistance during ambulation until orthostatic hypotension and motor deficits are ruled out.

Evaluation/Desired Outcomes

  • Decrease in postoperative pain without unwanted sensory or motor deficits.

Naropin®

Ropivacaine Neurology A long-acting anesthetic for obstetrics, locoregional anesthesia, post-op pain, surgical anesthesia, acute pain management

Naropin

A brand name for ROPIVACAINE.
Mentioned in ?
References in periodicals archive ?
Then, we injected the prepared mixture of 0.75% ropivacaine (10 ml, Naropin, AstraZeneca, Luton, UK) and saline (10 ml) with epinephrine (1:200,000), and a 19-gauge catheter was inserted 2 cm over the tip of the needle under real-time ultrasound guidance [Figure 1]b and [Figure 1]c.{Figure 1}
The trials will utilise PRF-110, a proprietary extended release version of ropivacaine (Naropin), which offers long relief of post-surgical incision pain.
Both the pivotal Phase III clinical trials will use the company's PRF-110, a proprietary extended release version of ropivacaine (Naropin) that provides long relief of post-surgical incision pain.
Only a handful of surgeons favored ropivacaine (Naropin).
Finally, a mixture of 0.2% ropivacaine (8 mL; Naropin; Astrazeneca Korea, Seoul, Republic of Korea) and 40% triamcinolone acetonide (20 mg; triamcinolone; DongKwang, Seoul, Republic of Korea) was slowly injected.
UK-based drugmaker AstraZeneca (NYSE: AZN) has entered into an agreement with Mauritius-based Aspen Group's Aspen Global Inc business under which AGI will now acquire the residual rights to the established anaesthetic medicines comprising of Diprivan, EMLA,Xylocaine/Xylocard/Xyloproct, Marcaine, Naropin, Carbocaine and Citanest, the company said.
There after a 22 gauge, 20 cm spinal needle was used to inject 10ml of a mixture of 1% lidocaine and 0.5% ropivacaine (Naropin, AstraZeneca AB, Sodertalje, Sweden).
The portfolio contains brands like Carbocaine, Citanest, Diprivan, Marcaine and Naropin, and it continues to generate stable revenue, with global product sales in 2015 of US$ 592mln.
FDA to market Naropin (ropivacaine HCL Injection, USP) 0.2% 100mL and 200mL premix bags in the company's Freeflex delivery system, which are now available for U.S.
The company manufactures products like EMLA, Diprivan, Betaloc, Atacanf, Tenorectic, Xyloproct, Naropin and Lexxel.
Local anaesthetic agents used were therapeutic formulations of bupivacaine 0.5% (Bupivacaine, Pfizer, West Ryde, Australia), lignocaine 1% (Xylocaine, AstraZeneca, North Ryde, Australia), prilocaine 0.5% (Citanest, AstraZeneca, North Ryde, Australia), and ropivacaine 0.5% (Naropin, AstraZeneca, North Ryde, Australia).
Local anesthetics are given by injection or topically, and include benzocaine, bupivacaine (Marcaine, Sensorcaine), chloroprocaine (Nesacaine), camphor, dibucaine (Nuper-cainal), levobupivacaine (Chirocaine), lidocaine (Xylocaine, Octocaine), mepivacaine (Carbocaine, Polocaine), pramoxine, prilocaine (Citanest), procaine (Novocaine), ropivacaine (Naropin), and tetracaine (Pontocaine).