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Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
Ropivacaine is marketed as an injectable solution for perineural and epidural administration for the treatment of acute pain and for anesthesia in surgery (i.e., peripheral nerve and ocular block; epidural administration for abdominal surgery, cesarean section and lower limb surgery, and intrathecal administration for orthopedics and urological surgeries). Ropivacaine has pharmacokinetic properties very similar to those of levobupivacaine: high binding to plasma proteins, hepatic drug metabolism with CYP1A2 and CYP3A4 isoenzymes involvement giving rise to the metabolites 3′-hydroxy-ropivacaine and 2′,6′-pipecoloxylidide, and primary renal excretion in form of these metabolites (Leone et al., 2008; Li et al., 2014; Sisk, 1992).
The pharmacological management of acute pain
Published in Alison Twycross, Anthony Moriarty, Tracy Betts, Paediatric Pain Management a multi-disciplinary approach, 2018
Alison Twycross, Anthony Moriarty, Tracy Betts
These side effects may be reduced or disappear with the use of ropivacaine, which allows a higher concentration of local anaesthetic to be used, and thus obviates the need for an additional opioid. When using ropivacaine, it is necessary to place the catheter close to the dermatomal level of the pain, and also to administer regular NSAIDs.
Epidural and spinal analgesia
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Almost every LA agent can be administered neuraxially. The first LA drugs to be used on a larger scale in the 1980s were of the ester type, such as procaine and tetracaine. These were then replaced by amino-amides (for example, lidocaine, bupivacaine) with an improved safety profile. When it was found that bupivacaine was associated with cardiac arrest and life-threatening arrhythmias, levobupivacaine and ropivacaine were introduced. These are S-enantiomers with similar anesthetic efficacy and reduced toxicity when compared to the racemic mixture.9 While levobupivacaine is less cardiotoxic, ropivacaine also appears to cause less motor blockade. A meta-analysis of neuraxial ropivacaine in obstetric analgesia suggests clinical advantages, notably a differential block with improved motor function, 10 but the clinical relevance of this aspect continues to be debated.
Comparative study of analgesic effect of epidural ketamine vs. epidural tramadol in patients undergoing mastectomy under thoracic epidural anesthesia
Published in Egyptian Journal of Anaesthesia, 2022
Mohammed A Raheem, Fawzy Abbas Badawy, Hitham MA. Elsayed
Baraka et al. [3] found that administration of 100 mg of ET resulted in a more decrease in VAS score in all times of scoring than our results. The difference can be due to the use of a larger dose of tramadol in their study compared with our study (1 mg/kg) and due to the different times of injection, as they gave ET at skin closure. In contrast, we gave epidural tramadol before the start of surgery. In other studies, Siddik et al. [32] compared two doses of tramadol dose (100 and 200 mg) with the control group who received no tramadol. They found that prolonged duration of analgesia was dose-dependent with tramadol but with a higher incidence of side effects especially vomiting. Also, a study done by Singh et al. [33], who compared two doses of thoracic ET, 1 and 2 mg/kg, added to ropivacaine 0.2% for providing analgesia after upper abdominal surgeries under general anesthesia found that lowering the VAS score and prolonged analgesia duration with the dose 2 mg/kg but associated with more side effects (nausea and vomiting).
Effects of intravenous lipid emulsions on the reversal of pacing-induced ventricular arrhythmias and electrophysiological alterations in an animal model of ropivacaine toxicity
Published in Clinical Toxicology, 2022
Matilde Zaballos, Ignacio Fernández, Lucia Rodríguez, Sergio García, Olalla Varela, Oscar Quintela, María-José Anadón, Jesús Almendral
After baseline PEVSP, ropivacaine was administered through a peripheral vein in the animal’s ear. Our objective was to develop a model of toxicity that would induce relevant electrophysiological alterations without causing the death of the animal. Following a pilot study, this objective was achieved with a ropivacaine dose of 5 mg·kg−1 and a continuous infusion of 100 μg·kg−1·min−1, maintained for 15 min. At 3 min after ropivacaine administration, the animals in the ILE group were given Intralipid 20%, 1.5 mL·kg−1 (20% Intralipid; Fresenius Kavi AB, Uppsala, Sweden) for >1 min through the peripheral vein, followed by an infusion of 0.25 mL·kg−1·min−1. The animals in the control group received a bolus of 50 mL of normal saline solution and an infusion of 3–5 mL·kg−1·h−1. After 25 min from the start of the ropivacaine infusion, a PEVSP identical to that performed at baseline was delivered, Figure 1.
Obesity decreases the EC50 of epidural ropivacaine when combined with dexmedetomidine for labor analgesia
Published in Expert Review of Clinical Pharmacology, 2021
Xiaojun Chen, Meng Cai, Xiaofeng Lei, Jin Yu
Based on the domestic standards for obesity before labor in parturients, maternal body mass index (BMI: weight [kg]/height2 [m2]) of ≥27 kg/m2 at labor was defined as AO [8,9]. Selected parturient women were allocated into the control (CON) group (maternal BMI<27) or AO group (maternal BMI ≥27) at labor. Epidural ropivacaine combined with dexmedetomidine (0.5 µg/mL) were administered to the parturients in both the groups. Based on the prescribed procedure of the up-and-down sequential technology [7,10], 20–40 cases were predicted to provide a stable estimate of EC50 with at least six crossovers. Thus, we allocated 30 parturient women in each group. The anesthetics used were ropivacaine hydrochloride injection (10 mL: 75 mg; AstraZeneca plc, UK) and dexmedetomidine hydrochloride injection (2 mL: 200 μg; Jiangsu Yangzijiang Pharmaceutical Group Co., Ltd, China).