Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/22 20:44:22」(JST)

wiki en

Ropivacaine (rINN) /roʊˈpɪvəkeɪn/ is a local anaesthetic drug belonging to the amino amide group. The name ropivacaine refers to both the racemate and the marketed S-enantiomer. Ropivacaine hydrochloride is commonly marketed by AstraZeneca under the trade name Naropin.

History

Ropivacaine was developed after bupivacaine was noted to be associated with cardiac arrest, particularly in pregnant women. Ropivacaine was found to have less cardiotoxicity than bupivacaine in animal models.

Clinical use

Indications

Ropivacaine is indicated for local anaesthesia including infiltration, nerve block, epidural and intrathecal anaesthesia in adults and children over 12 years. It is also indicated for peripheral nerve block and caudal epidural in children 1–12 years for surgical pain. It is also sometimes used for infiltration anaesthesia for surgical pain in children.

Ropivacaine is often coadministered with fentanyl for epidural analgesia, for example in pregnant women during labour.

Contraindications

Ropivacaine is contraindicated for intravenous regional anaesthesia (IVRA). However, new data suggested both ropivacaine (1.2-1.8 mg/kg in 40ml) and levobupivacaine (40 ml of 0.125% solution) be used, because they have less cardiovascular and central nervous system toxicity than racemic bupivacaine.^[1]

Adverse effects

Adverse drug reactions (ADRs) are rare when it is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia, however allergic reactions can rarely occur.

Systemic exposure to excessive quantities of ropivacaine mainly result in central nervous system (CNS) and cardiovascular effects – CNS effects usually occur at lower blood plasma concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures followed by depression (drowsiness, loss of consciousness), respiratory depression and apnea). Cardiovascular effects include hypotension, bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.^[2]

Treatment of overdose

As for bupivacaine, Celepid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose in animal experiments^[3] and in humans in a process called lipid rescue.^[4]^[5]^[6]

References

^ (Basic of Anesthesia, Robert Stoelting, page 289)
^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
^ Weinberg, G; Ripper, R; Feinstein, DL; Hoffman, W (2003). "Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity". Reg Anesth Pain Med 28 (3): 198–202. doi:10.1053/rapm.2003.50041. PMID 12772136.
^ Picard, J; Meek, T (2006). "Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob". Anaesthesia 61 (2): 107–9. doi:10.1111/j.1365-2044.2005.04494.x. PMID 16430560.
^ Rosenblatt, MA; Abel, M; Fischer, GW; Itzkovich, CJ; Eisenkraft, JB (2006). "Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest". Anesthesiology 105 (1): 217–8. doi:10.1097/00000542-200607000-00033. PMID 16810015.
^ Litz, RJ; Popp, M; Stehr, S N; Koch, T (2006). "Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion". Anaesthesia 61: 800–1. doi:10.1111/j.1365-2044.2006.04740.x. PMID 16867094.

External links

European Society of Anaesthesiologists: Use of ropivacaine in clinical practice
More on lipid rescue

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 脊髄麻酔：手技 spinal anesthesia technique
2. 末梢神経ブロックの概要 overview of peripheral nerve blocks
3. 眼の待機手術に対する麻酔 anesthesia for elective eye surgery
4. 重症筋無力症患者に対する麻酔 anesthesia for the patient with myasthenia gravis
5. 上肢神経ブロック：手技 upper extremity nerve blocks techniques

English Journal

Regional anaesthesia in neonates, infants and children: An educational review.

Jöhr M1.
European journal of anaesthesiology.Eur J Anaesthesiol.2015 May;32(5):289-97. doi: 10.1097/EJA.0000000000000239.
Prophylactic analgesia with local anaesthesia is widely used in children and has a good safety record. Performing regional blocks in anaesthetised children is a safe and generally accepted practice. When compared with adults, lower concentrations of local anaesthetics are sufficient in children; the
PMID 25693139

Sparing effects of sufentanil on epidural ropivacaine in elderly patients undergoing transurethral resection of prostate surgery.

Li H1, Li Y2, He R3.
Yonsei medical journal.Yonsei Med J.2015 May 1;56(3):832-7. doi: 10.3349/ymj.2015.56.3.832.
PURPOSE: This study examined the sparing effect of sufentanil on the median effective concentration (EC₅₀) of epidural ropivacaine in elderly patients undergoing elective transurethral resection of prostate (TURP).MATERIALS AND METHODS: This was a prospective randomized double-blind dose-respons
PMID 25837193

Combined saphenous and sciatic catheters for analgesia after major ankle surgery: a double-blinded randomized controlled trial.

Fisker AK1, Iversen BN, Christensen S, Linde F, Nielsen KK, Børglum J, Bendtsen TF.
Canadian journal of anaesthesia = Journal canadien d'anesthesie.Can J Anaesth.2015 Apr 8. [Epub ahead of print]
PURPOSE: Continuous sciatic nerve block is used for pain management following major ankle surgery. Pain from the saphenous nerve territory often persists. We conducted a double-blinded randomized placebo-controlled trial to evaluate the effect of a supplementary saphenous catheter in the proximal th
PMID 25851020

Japanese Journal

硬膜外麻酔による無痛分娩が分娩および新生児に与える影響について

久保田陽子,伊田昌功,伊藤宏一 [他]
産婦人科の進歩 66(3), 257-264, 2014-08
NAID 40020177890

臨床報告 0.75%塩酸ロピバカイン(アナベイン)を用いたテノン囊下麻酔による硝子体手術

高橋めぐみ,塙本宰,木原真一 [他]
臨床眼科 68(7), 1057-1061, 2014-07
NAID 40020132869

Lipid peroxidation - inhibitory effects of perioperatively used drugs associated with their membrane interactions.

Tsuchiya Hironori
Oxidants and antioxidants in medical science 3(2), 91-98, 2014-05-02
… The inhibition at 10 μM was greatest in propofol, followed by guaiacol, thiopental, thymol, phenol, midazolam, diazepam, lidocaine, eugenol, procaine, bupivacaine, ropivacaine, sevoflurane, ketamine, mepivacaine and prilocaine. …
NAID 120005603155

Related Pictures

★リンクテーブル★

リンク元	「ロピバカイン」
拡張検索	「ropivacaine hydrochloride hydrate」「ropivacaine hydrochloride」

「ロピバカイン」

Ropivacaine
Systematic (IUPAC) name
	(S)-N-(2,6-dimethylphenyl)-; 1-propylpiperidine-2-carboxamide
Clinical data
AHFS/Drugs.com	Consumer Drug Information
Pregnancy; category	AU: B1; ;
Routes of; administration	Parenteral
Legal status	AU: S4 (Prescription only);
Pharmacokinetic data
Bioavailability	87%–98% (epidural)
Metabolism	Hepatic (CYP1A2-mediated)
Biological half-life	1.6–6 hours (varies with administration route)
Excretion	Renal 86%
Identifiers
CAS Number	84057-95-4
ATC code	N01BB09 (WHO)
PubChem	CID 175805
IUPHAR/BPS	7602
DrugBank	DB00296
ChemSpider	153165
UNII	7IO5LYA57N
KEGG	D08490
ChEBI	CHEBI:8890
ChEMBL	CHEMBL1077896
Chemical data
Formula	C17H26N2O
Molar mass	274.4 g/mol
	SMILES O=C(Nc1c(cccc1C)C)[C@H]2N(CCC)CCCC2 ;
	InChI InChI=1S/C17H26N2O/c1-4-11-19-12-6-5-10-15(19)17(20)18-16-13(2)8-7-9-14(16)3/h7-9,15H,4-6,10-12H2,1-3H3,(H,18,20)/t15-/m0/s1 ; Key:ZKMNUMMKYBVTFN-HNNXBMFYSA-N ;
(verify)

　　[★]

英: ropivacaine、ropivacaine hydrochloride、ropivacaine hydrochloride hydrate
化: 塩酸ロピバカイン水和物 ropivacaine hydrochloride hydrate、塩酸ロピバカイン ropivacaine hydrochloride
商: アナペイン Anapeine

局所麻酔薬;アミド型;長時間作用性

添付文書

アナペイン注2mg/mL

http://www.info.pmda.go.jp/go/pack/1214405A1025_1_07/1214405A1025_1_07?view=body

「ropivacaine hydrochloride hydrate」

　　[★]

塩酸ロピバカイン水和物

関: ropivacaine、ropivacaine hydrochloride

「ropivacaine hydrochloride」

　　[★]

塩酸ロピバカイン

関: ropivacaine、ropivacaine hydrochloride hydrate

[1] (Basic of Anesthesia, Robert Stoelting, page 289)

[AMH2006-2] Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3

[Weinberg2003-3] Weinberg, G; Ripper, R; Feinstein, DL; Hoffman, W (2003). "Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity". Reg Anesth Pain Med 28 (3): 198–202. doi:10.1053/rapm.2003.50041. PMID 12772136.

[Picard2006-4] Picard, J; Meek, T (2006). "Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob". Anaesthesia 61 (2): 107–9. doi:10.1111/j.1365-2044.2005.04494.x. PMID 16430560.

[Rosenblatt2006-5] Rosenblatt, MA; Abel, M; Fischer, GW; Itzkovich, CJ; Eisenkraft, JB (2006). "Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest". Anesthesiology 105 (1): 217–8. doi:10.1097/00000542-200607000-00033. PMID 16810015.

[Litz2006-6] Litz, RJ; Popp, M; Stehr, S N; Koch, T (2006). "Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion". Anaesthesia 61: 800–1. doi:10.1111/j.1365-2044.2006.04740.x. PMID 16867094.

匿名

検索

案内

案内

ropivacaine