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Ropivacaine

A Review of its Pharmacology and Therapeutic Use in Regional Anaesthesia

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Abstract

Synopsis

The enantiomerically pure (S-enantiomer) amide local anaesthetic drug ropivacaine blocked nerve fibres responsible for transmission of pain (Aδ and fibres) more completely than those that control motor function (Aβ fibres) in in vitro studies. The drug shares the biphasic vascular effects common to the amide local anaesthetic drug class. In vitro studies indicate that ropivacaine is less cardiotoxic than equimolar concentrations of bupivacaine.

Apart from one trial in women undergoing hysterectomy, clinical studies that compared the efficacy of different doses of epidurally administered ropivacaine in patients undergoing various surgical procedures did not reveal any consistent dose-related differences with respect to sensory blockade. However, motor blockade did become more intense as the dose of ropivacaine increased.

Overall, direct comparisons show that epidural ropivacaine is less potent than epidural bupivacaine when the 2 drugs are administered at the same concentration. However, this difference is less marked in terms of sensory blockade than motor blockade. The greater degree of separation between motor and sensory blockade seen with ropivacaine relative to bupivacaine is more apparent at the lower end of the dosage scale. Nevertheless, higher doses of ropivacaine than bupivacaine are generally required to elicit equivalent anaesthetic effects.

Ropivacaine has been shown to induce successful brachial plexus anaesthesia when given at a concentration of 5 mg/ml, but not 2.5 mg/ml, and was as effective as bupivacaine in comparative studies in this indication.

Limited data indicate that continuous epidural infusion of ropivacaine post-operatively reduces postsurgical pain in a dose-related manner. Morphine consumption was also reduced. Higher doses of ropivacaine were significantly more effective than placebo. Similarly, ropivacaine controlled postsurgical pain when infiltrated directly into surgical wound sites (i.e. wound infiltration) and was as effective as bupivacaine, and more effective than placebo, in this regard.

Adverse events associated with epidurally administered ropivacaine include hypotension, nausea, bradycardia, transient paraesthesia, back pain, urinary retention and fever. The drug appears to have an adverse event profile similar to that of bupivacaine.

In animal studies, overdoses of ropivacaine were better tolerated than overdoses of bupivacaine but not lidocaine (lignocaine). Human volunteers tolerated a higher intravenous dosage of ropivacaine than bupivacaine before developing initial signs of toxicity.

Thus, ropivacaine, according to animal data, is less cardiotoxic than bupivacaine. Based on available clinical data, ropivacaine appears to be as effective and well tolerated as bupivacaine when equianalgesic doses are compared. The greater degree of separation between motor and sensory blockade seen with ropivacaine relative to bupivacaine at lower concentrations (≈5 mg/ml) will be advantageous in certain applications.

Pharmacodynamic Properties

Ropivacaine is an enantiomerically pure (S-enantiomer) amide local anaesthetic drug. In in vitro preparations of animal nerves ropivacaine was more selective for nerve fibres responsible for transmission of pain (AS and C fibres) than those that control motor function (Aβ fibres). The drug also induced profound blockade of other animal nerves in vitro and appeared to be more potent than equimolar concentrations of bupivacaine in this regard.

Small volumes of ropivacaine injected intradermally have a vasoconstrictive effect. Similarly, in human tissues in vitro, low concentrations of ropivacaine induced vasoconstriction; however, in keeping with the biphasic vascular effects of amide local anaesthetic drugs, this was reversed at higher concentrations.

In anaesthetised pigs, a high intra-arterial dose of ropivacaine (5.33mg) significantly decreased mean arterial pressure and left ventricular dP/dT, and increased left ventricular end-diastolic pressure.

In guinea-pig cardiac muscle in vitro, ropivacaine-induced blockade of sodium channels was less potent than that induced by bupivacaine. In rabbit Purkinje fibres, ropivacaine depressed cardiac excitability and conduction to a lesser extent than bupivacaine but more so than lidocaine (lignocaine). Ropivacaine was less cardiotoxic than equivalent concentrations of bupivacaine in isolated perfused rabbit hearts. In vivo studies in pigs and dogs indicate that ropivacaine has less effect on cardiac rhythm than equianalgesic doses of bupivacaine but affects cardiac rhythm more than lidocaine.

Studies evaluating the effects of epidural administration of ropivacaine to volunteers indicate that the duration of sensory anaesthesia is dose dependent. The effects of the drug on lower extremity motor function clearly increased as the dose increased.

Pharmacokinetic Properties

Intravenous infusion of ropivacaine 50mg over a 15-minute period produced a mean maximum plasma concentration (Cmax) of 1.5 mg/L. The mean volume of distribution of unbound drug (6%) was 742L, plasma clearance was 0.5 L/h and the terminal elimination half-life was 1.85 hours.

In patients undergoing orthopaedic surgery, epidural injection of ropivacaine 100, 150 or 200mg produced Cmax values of 0.53, 1.07 and 1.53 mg/L, respectively after 96 (100mg) or 40 (150 or 200mg) minutes (tmax). Mean residence time was inversely proportional to the dose but the area under the plasma concentration versus time curve was not dose-dependent. Similar trends were observed in patients undergoing other types of surgery including hysterectomy, hernia repair or varicose vein stripping. Compared with bupivacaine, ropivacaine has a signifi-cantly shorter elimination half-life (≈5 vs ≈10 hours) but is cleared at a similar rate (apparent plasma clearance ≈18 L/h). Continuous infusion of ropivacaine over a 21-hour period was associated with a continuous increase in plasma concentration. Compared with data from bolus dose studies, the apparent plasma clearance of the drug was higher and the half-life shorter.

Therapeutic Use

Most studies evaluating the efficacy of ropivacaine have involved epidural administration of the drug to patients undergoing surgery and, to a lesser extent, women in labour.

Apart from one study in women undergoing hysterectomy, ascending dose studies in patients undergoing a wide range of surgical procedures did not detect any dose-related trends in terms of the time taken to reach the maximum level of analgesia. However, the duration of anaesthesia and the degree of motor blockade increased as the dosage of ropivacaine increased.

Overall, double-blind comparisons in patients undergoing a variety of surgical procedures show that ropivacaine is less potent than bupivacaine in terms of motor blockade and, to a lesser extent, sensory blockade. Several studies in women undergoing caesarean section reported a significantly longer time to onset of motor blockade in ropivacaine recipients compared with bupivacaine recipients. Differences between the 2 drugs in terms of sensory blockade were less pronounced. All studies used equivalent dosages of each drug. In contrast, a study in patients undergoing urological surgery, which also compared equivalent dosages of ropivacaine and bupivacaine [150mg (7.5 mg/ml)], reported a similar time to onset of motor blockade with both drugs, but a significantly lower frequency of second and third degree motor block in ropivacaine recipients. Importantly, studies that compared ropivacaine and bupivacaine at a dose ratio of approximately 1.5 to 1 (for example ropivacaine 7.5 mg/ml vs bupivacaine 5 mg/ml) reported very similar patterns of motor and sensory blockade in both groups.

All of 3 noncomparative trials conducted to evaluate the anaesthetic efficacy of ropivacaine 150 or 165mg administered via the subclavian perivascular approach found the drug to induce satisfactory brachial plexus block in patients scheduled to undergo upper limb surgery. In all of these studies 50% of patients received epinephrine. Anaesthesia of brachial plexus dermatomes was achieved in between 86 and 100% of patients. In a randomised double-blind dosage comparison, the extent of brachial plexus nerve block achieved with ropivacaine 2.5 mg/ml (100mg dose) was significantly less useful than that provided by ropivacaine 5 mg/ml (200mg dose). The drug was as effective as bupivacaine in comparative studies in this indication.

Direct comparisons indicate that epidurally administered ropivacaine has generally similar efficacy to bupivacaine when given for pain relief during labour. In one study, a significantly shorter time to onset of analgesia was noted in bupivacaine than in ropivacaine recipients, and motor blockade was slightly less intense after ropivacaine in another. In all of these studies, neonatal outcome, assessed using Apgar scores, was not significantly affected and was similar with both drugs. A further trial, designed specifically to compare the effects of maternal epidural ropivacaine (mean dose 75mg) and bupivacaine (mean dose 85mg) on neonatal neurobehavioural status and outcome, reported no significant differences between the 2 groups. In contrast, a meta-analysis reported significantly higher neurological and adaptive capacity scores at 24 hours in infants born to mothers given epidural ropivacaine than in those born to mothers given bupivacaine.

The postsurgical analgesic efficacy of continuous epidural infusion of ropivacaine 10, 20 and 30 mg/h has been compared with that of placebo (saline) in patients undergoing upper or lower abdominal, or orthopaedic surgery. In all studies the drug was infused postoperatively. Pain became proportionally less severe and morphine consumption (when measured) decreased as the dosage of ropivacaine increased. Indeed, all studies reported a significant difference between higher doses of ropivacaine placebo. Motor blockade became more intense as the dosage of ropivacaine increased.

Two methods of wound infiltration have been investigated: preoperative subcutaneous infiltration along the line of the proposed incision and postoperative injection of the drug into the wound. In a dose-finding study, ropivacaine provided dose-related control of pain after hernia repair. Ropivacaine 100 to 175mg was significantly more effective than placebo (saline) when given just prior to chole-cystectomy and as effective as bupivacaine given immediately after herniotomy.

Tolerability

Most clinical trials evaluating the anaesthetic efficacy of ropivacaine included only an overview of adverse events data. In studies evaluating the efficacy of the drug administered epidurally, reported adverse events included hypotension, nausea, bradycardia, transient paraesthesia, back pain, urinary retention and fever. In direct comparisons between ropivacaine and bupivacaine the 2 drugs were associated with a similar incidence of adverse events.

Studies that compared the effects of overdoses of ropivacaine, bupivacaine and lidocaine in conscious animals reported a higher tolerance to ropivacaine than to bupivacaine, but not lidocaine. Similarly, human volunteers tolerated a significantly higher cumulative intravenous dosage of ropivacaine than bupivacaine before developing mild CNS toxicity (124 vs 99mg).

Dosage and Administration

Recommended epidural doses of ropivacaine for surgical anaesthesia range between 113 and 200mg. Different doses can be achieved by varying either the concentration or volume of solution injected. Epidural ropivacaine administered to control postsurgical pain can be given as a 20 to 40mg bolus with 20 to 30mg top-up doses at ≥30-minute intervals or as a 2 mg/ml continuous epidural infusion at a rate of 6 to 14 ml/h (lumbar) or 4 to 8 ml/h (thoracic).

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References

  1. Federsei H, Jaksch P, Sandberg R, et al. An efficient synthesis of a new, chiral 2’,6’-pipecoloxylidide local anaesthetic agent. Acta Chem Scand 1987; 41: 757–61

    Article  Google Scholar 

  2. Marsh CR, Hardy AJ. Ropivacaine: a new local anaesthetic agent. Br J Hosp Med 1991 Feb; 45: 94–5

    CAS  PubMed  Google Scholar 

  3. Barr ML, Kiernan JA. Peripheral nervous system. In: The human nervous system. 4th ed. Philadelphia: Harper & Row, 1983

    Google Scholar 

  4. Wildsmith JAW, Brown DT, Paul D, et al. Structure-activity relationships in differential nerve block at high and low frequency stimulation. Br J Anaesth 1989; 63: 444–52

    Article  CAS  PubMed  Google Scholar 

  5. Rosenberg PH, Heinonen E. Differential sensitivity of A and nerve fibres to long-acting amide local anaesthetics. Br J Anaesth 1983 Feb; 55: 163–7

    Article  CAS  PubMed  Google Scholar 

  6. Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anaesthesiol Scand 1988 Oct; 32: 571–8

    Article  CAS  PubMed  Google Scholar 

  7. Millay DJ, Larrabee Jr WF, Carpenter RL. Vasoconstrictors in facial plastic surgery. Arch Otolaryngol Head Neck Surg 1991 Feb; 117: 160–3

    Article  CAS  PubMed  Google Scholar 

  8. Kopacz DJ, Carpenter RL, Mackey DC. Effect of ropivacaine on cutaneous capillary blood flow in pigs. Anesthesiology 1989 Jul; 71: 69–74

    Article  CAS  PubMed  Google Scholar 

  9. Cederholm I, Akerman B, Evers H. Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man. Acta Anaesthesiol Scand 1994 May; 38: 322–7

    Article  CAS  PubMed  Google Scholar 

  10. Dahl JB, Simonsen L, Mogensen T, et al. The effect of 0.5% ropivacaine on epidural blood flow. Acta Anaesthesiol Scand 1990 May; 34: 308–10

    Article  CAS  PubMed  Google Scholar 

  11. Guinard J-P, Carpenter RL, Owens BD, et al. Comparison between ropivacaine and bupivacaine after subcutaneous injection in pigs; cutaneous blood flow and surgical bleeding. Reg Anesth 1991 Sep-Oct; 16: 268–71

    CAS  PubMed  Google Scholar 

  12. Nakamura K, Toda H, Kakuyama M, et al. Direct vascular effect of ropivacaine in femoral artery and vein of the dog. Acta Anaesthesiol Scand 1993 Apr; 37: 269–73

    Article  CAS  PubMed  Google Scholar 

  13. Gherardini G, Samuelson U, Jernbeck J, et al. Comparison of vascular effects of ropivacaine and lidocaine on isolated rings of human arteries. Acta Anaesthesiol Scand 1995 Aug; 39: 765–8

    Article  CAS  PubMed  Google Scholar 

  14. Reiz S, Häggmark S, Johansson G, et al. Cardiotoxicity of ropivacaine — a new amide local anaesthetic agent. Acta Anaesthesiol Scand 1989 Feb; 33: 93–8

    Article  CAS  PubMed  Google Scholar 

  15. Santos AC, Arthur GR, Roberts DJ, et al. Effect of ropivacaine and bupivacaine on uterine blood flow in pregnant ewes. Anesth Analg 1992 Jan; 74: 62–7

    Article  CAS  PubMed  Google Scholar 

  16. Arlock P. Actions of three local anaesthetics: lidocaine, bupivacaine and ropivacaine on guinea pig papillary muscle sodium channels (Vmax). Pharmacol Toxicol 1988 Aug; 63: 96–104

    Article  CAS  PubMed  Google Scholar 

  17. Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction: fast block of sodium channels during the action potential with a slow recovery from block during diastole. Anesthesiology 1985 Apr; 62: 396–405

    Article  CAS  PubMed  Google Scholar 

  18. Valenzuela C, Delpón E, Franqueza L, et al. Effects of (S)-ropivacaine on human cardiac delayed rectifier (Kv 1.5) channels [abstract]. Methods Find Exp Clin Pharmacol 1995; 17 Suppl. A: 51

    Google Scholar 

  19. Wulf H, Petry A, Godicke J. The cardiac effects of bupivacaine and ropivacaine on contractility and action potentials of isolated guinea pig atria. Influence of different extra-cellular potassium concentrations [in German]. Anaesthesist 1993 Aug; 42: 516–20

    CAS  PubMed  Google Scholar 

  20. Moller R, Covino BG. Cardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine, a new amide local anesthetic. Anesthesiology 1990 Feb; 72: 322–9

    Article  CAS  PubMed  Google Scholar 

  21. Moller RA, Covino BG. Effect of progesterone on the cardiac electrophysiologic alterations produced by ropivacaine and bupivacaine. Anesthesiology 1992 Oct; 77: 735–41

    Article  CAS  PubMed  Google Scholar 

  22. Pitkanen M, Feldman HS, Arthur GR, et al. Chronotropic and inotropic effects of ropivacaine, bupivacaine, and lidocaine in the spontaneously beating and electrically paced isolated, perfused rabbit heart. Reg Anesth 1992 Jul-Aug; 17: 183–92

    CAS  PubMed  Google Scholar 

  23. Pedigo NW, Walmsley PN, Kasten GW, et al. Relative cardiotoxicity of the long-acting local anesthetics bupivacaine and ropivacaine in dogs [abstract]. Anesth Analg 1988; 67 Suppl.: S166

    Article  Google Scholar 

  24. Zaric D, Axelsson K, Nydahl P-A, et al. Sensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine — a double-blind study. Anesth Analg 1991 Apr; 72: 509–15

    Article  CAS  PubMed  Google Scholar 

  25. Zaric D, Axelsson K, Philipson L, et al. Blockade of the abdominal muscles measured by EMG during lumbar epidural analgesia with ropivacaine — a double-blind study. Acta Anaesthesiol Scand 1993 Apr; 37: 274–80

    Article  CAS  PubMed  Google Scholar 

  26. Zarich D, Nydahl P-A, Philipson L, et al. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, and 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers. Reg Anesth 1996; 21(1): 14–25

    Google Scholar 

  27. Lee A, Fagan D, Lamont M, et al. Disposition kinetics of ropivacaine in humans. Anesth Analg 1989 Dec; 69: 736–8

    Article  CAS  PubMed  Google Scholar 

  28. Tucker GT. Pharmacokinetics of local anaesthetics. Br J Anaesth 1986; 58: 717–31

    Article  CAS  PubMed  Google Scholar 

  29. Katz JA, Bridenbaugh PO, Knarr DC, et al. Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg 1990 Jan; 70: 16–21

    Article  CAS  PubMed  Google Scholar 

  30. Sandier A, Finucane B, McKenna J, et al. A pharmacokinetic comparison between ropivacaine 0.5%, 0.75%, 1.0% and bupivacaine 0.5% in epidural anaesthesia: a double blind multi centre study in women undergoing hysterectomy [abstract]. Can J Anaesth 1995 May; 42 (Pt 2): A43

    Google Scholar 

  31. Morrison LMM, Emanuelsson BM, McClure JH, et al. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth 1994 Feb; 72: 164–9

    Article  CAS  PubMed  Google Scholar 

  32. Emanuelsson B-MK, Zaric D, Nydahl P-A, et al. Pharmacokinetics of ropivacaine and bupivacaine during 21 hours of continuous epidural infusion in healthy male volunteers. Anesth Analg 1995 Dec; 81: 1163–8

    CAS  PubMed  Google Scholar 

  33. Erichsen C-J, Sjövall J, Kehlet H, et al. Pharmacokinetics and analgesic effect of ropivacaine during continuous epidural infusion for postoperative pain relief. Anesthesiology 1996; 84: 834–42

    Article  CAS  PubMed  Google Scholar 

  34. Oda Y, Furuichi K, Tanaka K, et al. Metabolism of a new local anesthetic, ropivacaine, by human hepatic cytochrome P450. Anesthesiology 1995 Jan; 82: 214–20

    Article  CAS  PubMed  Google Scholar 

  35. Brockway MS, Bannister J, McClure JH, et al. Comparison of extradural ropivacaine and bupivacaine. Br J Anaesth 1991 Jan; 66: 31–7

    Article  CAS  PubMed  Google Scholar 

  36. Whitehead E, Arrigoni B, Bannister J. An open study of ropivacaine in extradural anaesthesia. Br J Anaesth 1990 Jan; 64: 67–71

    Article  CAS  PubMed  Google Scholar 

  37. Kerkkamp HEM, Axelsson KH, Edstrom HH, et al. An open study comparison of 0.5-percent, 0.75-percent and 1.0-percent ropivacaine, with epinephrine, in epidural anesthesia in patients undergoing urologic surgery. Reg Anesth 1990 Mar-Apr; 15: 53–8

    CAS  PubMed  Google Scholar 

  38. Cederholm I, Anskär S, Bengtsson M. Sensory, motor, and sympathetic block during epidural analgesia with 0.5% and 0.75% ropivacaine with and without epinephrine. Reg Anesth 1994 Jan-Feb; 19: 18–33

    CAS  PubMed  Google Scholar 

  39. Kerkkamp HEM, Gielen MJM, Edstrom HH. Comparison of 0.75% ropivacaine with epinephrine and 0.75% bupivacaine with epinephrine in lumbar epidural anesthesia. Reg Anesth 1990 Jul-Aug; 15: 204–7

    CAS  PubMed  Google Scholar 

  40. Wood MB, Rubin AP. Acomparison of epidural 1 % ropivacaine and 0.75% bupivacaine for lower abdominal gynecologic surgery. Anesth Analg 1993 Jun; 76: 1274–8

    CAS  PubMed  Google Scholar 

  41. Finucane Sandler AN, McKenna J, et al. A double-blind comparison of ropivacaine 0.5%, 0.75%, 1.0% and bupivacaine 0.5%, injected epidurally, in patients undergoing abdominal hysterectomy. Can J Anaesth 1996; 43: 442–9

    Article  Google Scholar 

  42. Tuttle AA, Katz JA, Bridenbaugh PO, et al. A double blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine [abstract no. A884]. Anesthesiology 1993 Sep; 79

  43. Datta S, Camann W, Bader A, et al. Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section. Anesthesiology 1995 Jun; 82: 1346–52

    Article  CAS  PubMed  Google Scholar 

  44. Alahuhta S, Räsänen J, Jouppila P, et al. The effects of epidural ropivacaine and bupivacaine for Cesarean section on utero-placental and fetal circulation. Anesthesiology 1995 Jul; 83: 23–32

    Article  CAS  PubMed  Google Scholar 

  45. Griffin RP, Reynolds F. Extradural anaesthesia for caesarean section: a double-blind comparison of 0.5% ropivacaine with 0.5% bupivacaine. Br J Anaesth 1995 May; 74: 512–6

    Article  CAS  PubMed  Google Scholar 

  46. Reid D, Finucane B, Sandier A, et al. Epidural anaesthesia for caesarean section — a double blind comparison between 0.5% ropivacaine and 0.5% bupivacaine [abstract]. Can J Anaesth 1995 May; 42 (Pt 2): A46

    Article  Google Scholar 

  47. Concepcion M, Arthur GR, Steele SM, et al. A new local anesthetic, ropivacaine. Anesth Analg 1990 Jan; 70: 80–5

    Article  CAS  PubMed  Google Scholar 

  48. Niesel HC, Eilingsfeld T, Kaiser H, et al. Ropivàcaine in epidural analgesia — dose-response study in orthopedic surgery [in German]. Anaesthesist 1990 May; 39: A73–7

    Google Scholar 

  49. Thompson GE, Brown DL, Carpenter RL. Ropivacaine epidural anesthesia: an initial study in humans [abstract]. Anesth Analg 1989; 68: 6

    Article  Google Scholar 

  50. Wahedi W, Nolte H, Witte P. Ropivacaine in epidural anesthesia — dose-response relationship and comparison with bupivacaine [in German]. Anaesthesist 1990 May; 39: 57–65

    Google Scholar 

  51. Brown DL, Carpenter RL, Thompson GE. Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery. Anesthesiology 1990 Apr; 72: 633–6

    Article  CAS  PubMed  Google Scholar 

  52. Katz JA, Knarr D, Bridenbaugh PO. A double-blind comparison of 0.5-percent bupivacaine and 0.75-percent ropivacaine administered epidurally in humans. Reg Anesth 1990 Sep-Oct; 15: 250–2

    CAS  PubMed  Google Scholar 

  53. Niesel HC, Eilingsfeld T, Hornung M, et al. Ropivacaine 1% versus bupivacaine 0.75% without a vasoconstrictor. A comparative study of epidural anesthesia in orthopedic surgery [in German]. Anaesthesist 1993 Sep; 42: 605–11

    CAS  PubMed  Google Scholar 

  54. Wahedi W, Nolte H, Trombitas G, et al. The equipotency of ropivacaine, bupivacaine and etidocaine [in German]. Reg Anaesth 1990 May; 13: 66–72

    CAS  PubMed  Google Scholar 

  55. Wolff AP, Hasselström L, Kerkkamp HE, et al. Extradural ropivacaine and bupivacaine in hip surgery. Br J Anaesth 1995 Apr; 74: 458–60

    Article  CAS  PubMed  Google Scholar 

  56. Kalpokas M, Buckland M, Torda T. Ropivacaine epidurals for orthopaedic surgery [abstract]. Anaesth Intensive Care 1994 Aug; 22: 486

    Google Scholar 

  57. Concepcion M, Steele S, Bader A, et al. Comparison of 0.75% ropivacaine and 0.75% bupivacaine for epidural anesthesia [abstract]. Anesthesiology 1990 Sep; 73 Suppl.

  58. Hickey R, Candido KD, Ramamurthy S, et al. Brachial plexus block with a new local anaesthetic: 0.5 per cent ropivacaine. Can J Anaesth 1990 Oct; 37: 732–8

    Article  CAS  PubMed  Google Scholar 

  59. Winnie AP, Raza SM, Candido KD, et al. An exploratory study of 0.5% ropivacaine with epinephrine and 0.5% ropivacaine without epinephrine when used for brachial plexus anesthesia in patients undergoing surgery of the upper limb [abstract]. Reg Anesth 1989; 17 Suppl. 25: 67

    Google Scholar 

  60. Ramamurthy S, Blanchard J, Hickey R, et al. Efficacy of a new local anesthetic — 0.5% ropivacaine — for brachial plexus block [abstract]. Anesth Analg 1989; 68 Suppl.: S230

    Google Scholar 

  61. Tryba M, Zenz M, Thole H, et al. Ropivacaine 0.5% vs ropivacaine 0.25% for axillary brachial plexus anesthesia — a double blind study [abstract]. Anesthesiology 1992 Sep; 77 Suppl.: A891

    Article  Google Scholar 

  62. Hickey R, Rowley CL, Candido KD, et al. A comparative study of 0.25% ropivacaine and 0.25% bupivacaine for brachial plexus block. Anesth Analg 1992 Oct; 75: 602–6

    Article  CAS  PubMed  Google Scholar 

  63. Hickey R, Hoffman J, Ramamurthy S. A comparison of ropivacaine 0.5% and bupivacaine 0.5% for brachial plexus block. Anesthesiology 1991 Apr; 74: 639–42

    Article  CAS  PubMed  Google Scholar 

  64. McGlade D, Kalpokas M, Chamley D, et al. Ropivacaine for brachial plexus block [abstract]. Anaesth Intensive Care 1994 Aug; 22: 486–7

    Google Scholar 

  65. McCrae AF, Jozwiak H, McClure JH. Comparison of ropivacaine and 0.25% bupivacaine in extradural analgesia for the relief of pain in labour. Br J Anaesth 1995 Mar; 74: 261–5

    Article  CAS  PubMed  Google Scholar 

  66. Eddleston JM, Holland JJ, Griffin RP, et al. A double-blind comparison of 0.25% ropivacaine and bupivacaine for extradural analgesia in labour. Br J Anaesth 1996; 76: 66–71

    Article  CAS  PubMed  Google Scholar 

  67. Stienstra R, Jonker TA, Bourdrez P, et al. Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blind comparison. Anesth Analg 1995 Feb; 80: 285–9

    CAS  PubMed  Google Scholar 

  68. Gatt S, Crooke D, Lockley S, et al. A double-blind, randomized, parallel investigation into neurobehavioural status and outcome of infants born to mothers receiving epidural ropivacaine 0.25% and bupivacaine 0.25% for analgesia in labour [abstract]. Anaesth Intensive Care 1996 Feb; 24(1): 108

    Google Scholar 

  69. Writer WD, Ahlen Hedlund et al. Ropivacaine compared to bupivacaine for epidural labour analgesia: a prospective meta-analysis [abstract]. Proceedings of the International Symposium of Regional Anaesthesia, 1996 Apr 9-11, Auckland, 236

    Google Scholar 

  70. Schug SA, Scott DA, Payne J, et al. Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. Br J Anaesth 1996 Apr; 76: 487–91

    Article  CAS  PubMed  Google Scholar 

  71. Finucane Yeh TW, O’Callaghan-Enright S, et al. Thoracic epidural infusions of ropivacaine (0.1%, 0.2%, 0.3%) vs placebo following upper abdominal surgery: a double-blind study [abstract]. Reg Anesth 1995; 20 Suppl. 2: 35

    Google Scholar 

  72. Scott DA, Chamley DM, Mooney PH, et al. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery — a dose finding study. Anesth Analg 1995 Nov; 81: 982–6

    CAS  PubMed  Google Scholar 

  73. Badner NH, Reid D, Sullivan P, et al. Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopedic surgery: a dose finding study [abstract no. A1017]. Anesthesiology 1994 Sep; 81

  74. Binning AR, Wallis CB, Forbes DF, et al. Continuous extradural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: a dose finding study [abstract]. Br J Anaesth 1995 May; 74 Suppl. 1: 80

    Google Scholar 

  75. Turner G, Blake D, Buckland M, et al. Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery. Br J Anaesth 1996; 76: 606–10

    Article  CAS  PubMed  Google Scholar 

  76. Johansson B, Glise H, Hallerbäck et al. Preoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy. Anesth Analg 1994 Feb; 78: 210–4

    Article  CAS  PubMed  Google Scholar 

  77. Mulroy MF, Burgess FW, Carpenter RL, et al. Ropivacaine for postoperative wound infiltration following herniorraphy [abstract no. A1014]. Anesthesiology 1994 Sep; 81

  78. Erichsen CJ, Vibits H, Dahl JB, et al. Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy. Acta Anaesthesiol Scand 1995 Jan; 39: 67–70

    Article  CAS  PubMed  Google Scholar 

  79. Clinical safety. In: Naropin® (ropivacaine HC1) product monograph. Oxford: Oxford Clinical Communications, 1996: 17–8

    Google Scholar 

  80. Fusi L, Steer PJ, Maresh MJA, et al. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet 1989 Jun 3; I: 1250–2

    Article  Google Scholar 

  81. McClure JH. Ropivacaine. Br J Anaesth 1996 Feb; 76: 300–7

    Article  CAS  PubMed  Google Scholar 

  82. Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog. Anesth Analg 1989 Dec; 69: 794–801

    CAS  PubMed  Google Scholar 

  83. Feldman HS, Arthur GR, Pitkanen M, et al. Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine and bupivacaine in the conscious dog. Anesth Analg 1991 Oct; 73: 373–84

    Article  CAS  PubMed  Google Scholar 

  84. Rutten AJ, Nancarrow C, Mather LE, et al. Hemodynamic and central nervous system effects of intravenous bolus doses of lidocaine, bupivacaine, and ropivacaine in sheep. Anesth Analg 1989 Sep; 69: 291–9

    Article  CAS  PubMed  Google Scholar 

  85. Nancarrow C, Rutten AJ, Runciman WB, et al. Myocardial and cerebral drug concentrations and the mechanisms of death after fatal intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg 1989 Sep; 69: 276–83

    Article  CAS  PubMed  Google Scholar 

  86. Scott DB, Lee A, Fagan D, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989 Nov; 69: 563–9

    CAS  PubMed  Google Scholar 

  87. Knudsen K, Beckman M, Blomberg S, et al. Central nervous and cardiovascular effects during intravenous infusions of ropivacaine, bupivacaine and placebo in healthy volunteers [abstract]. Int Mon Reg Anes 1995 Sep (Special Abstract Issue): 15

  88. International data sheet. In: Naropin® (ropivacaine HC1) product monograph. Oxford: Oxford Clinical Communications, 1996: 42–52

    Google Scholar 

  89. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979 Oct; 51: 285–7

    Article  CAS  PubMed  Google Scholar 

  90. Sage DJ, Feldman HS, Arthur GR, et al. The cardiovascular effects of convulsant doses of lidocaine and bupivacaine in the conscious dog. Reg Anesth 1985; 10(4): 175–83

    CAS  Google Scholar 

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Various sections of the manuscript reviewed by: D.R. Ahernethy, Division of Clinical Pharmacology, Departments of Pharmacology and Medicine, Georgetown University Medical Center, Washington D.C., USA; I. Ceaerholm, Department of Cardiovascular and Thoracic Anaesthesia, University Hospital, Linköping, Sweden; H.S. Feldman, Department of Anesthesia Research Laboratories, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; B.T. Finucane, Department of Anaesthesia, University of Alberta, Edmonton, Alberta, Canada; S.P. Gatt, Department of Anaesthesia, Royal Hospital for Women, University of New South Wales Medical School, Sydney, New South Wales, Australia; R. Hickey, Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; K. Nakamura, Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan; G.T. Tucker, University Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, England; J.A.W. Wildsmith, University Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee, Scotland

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Markham, A., Faulds, D. Ropivacaine. Drugs 52, 429–449 (1996). https://doi.org/10.2165/00003495-199652030-00012

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