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[Pharmacology](https://durgical.com/en/pharmacology/) · [Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/)

# Ropivacaine

Long-acting amide local anaesthetic, related to bupivacaine but less cardiotoxic. Used for epidurals, nerve blocks and infiltration.

Updated 2026-11-01

- Class: [Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/)
- Ion channel: Voltage-gated sodium channels (Nav)
- ATC code: N01BB09

Also called: Ropivacaine hydrochloride

⇅**Voltage-gated sodium channels (Nav)**Ropivacaine

ⓘ There is no structure with ropivacaine. The figure shows levobupivacaine, a very similar local anaesthetic (also an S-enantiomer), in the inner pore of the human Nav1.7 sodium channel.

**Target in 3D:** Voltage-gated sodium channels (Nav). PDB structure 8I5B (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8I5B) · Drag to rotate · pinch to zoom

## Mechanism of action

Ropivacaine blocks the voltage-gated sodium channel from inside the axon, like other local anaesthetics, and prevents the generation and conduction of nerve impulses. It is made as the pure S-enantiomer, because it is less toxic than the R form; it was developed in search of a long-acting local anaesthetic with less cardiac toxicity than bupivacaine. It is somewhat less potent than bupivacaine.

- The un-ionised form crosses the axon membrane
- Blocks the sodium channel from inside
- Pain conduction stops for hours
- Pure S-enantiomer: less cardiotoxic than bupivacaine

## Pharmacokinetics

**Metabolism**
Hepatic; CYP1A2 forms its main metabolite, 3-hydroxy-ropivacaine.

**Elimination**
Kidney, mostly as metabolites.

## Indications

- Surgical anaesthesia: epidural (including caesarean section), major nerve blocks and infiltration
- Acute pain: continuous or bolus epidural infusion (postoperative or labour) and infiltration

## Adverse effects

### Common

- Hypotension
- Nausea and vomiting
- Bradycardia
- Paraesthesia

### Serious (rare, important)

- Systemic toxicity from intravascular injection: seizures, arrhythmias and cardiac arrest
- Methaemoglobinaemia
- Chondrolysis with intra-articular infusions

## Contraindications

- Hypersensitivity to ropivacaine or amide-type local anaesthetics

## Key interactions

**Strong CYP1A2 inhibitors (for example, fluvoxamine)**
Greatly reduce its clearance and raise its levels.

**Other local anaesthetics and related antiarrhythmics**
Additive toxicity.

**Drugs that cause methaemoglobinaemia**
Higher risk of methaemoglobinaemia.

## What is monitored

- Blood pressure, heart rate, ECG and saturation
- Consciousness and early signs of toxicity
- Level of sensory and motor block

## Administration and safety

- For infiltration, nerve block and epidural use only; not for intravenous use or spinal anaesthesia.
- Aspirate before injecting and fractionate the dose; keep resuscitation equipment and lipid emulsion available.
- Not for intra-articular infusions.

## Nursing care

- During epidural infusions: blood pressure, heart rate, block level and leg strength.
- If perioral numbness, tinnitus or agitation appear: stop the infusion and call for help.
- Check the catheter site and the integrity of the system.

## Pregnancy and breastfeeding

Used epidurally in labour and caesarean section; it crosses the placenta rapidly and can cause maternal, fetal or neonatal toxicity.

## Memory aid

ROPIvacaine: bupivacaine's «careful cousin»: just as long, but gentler on the heart.

## Test yourself

Think of the answer, then tap the question to see it.

## Why was ropivacaine developed?

To have a long-acting local anaesthetic with less cardiac toxicity than bupivacaine; it is marketed as the pure S-enantiomer.

## Which enzyme inhibitor can greatly raise ropivacaine levels?

A strong CYP1A2 inhibitor, such as fluvoxamine.

## Is ropivacaine more or less potent than bupivacaine?

Somewhat less potent.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/ropivacaine/)

## Related drugs

- [Bupivacaine](https://durgical.com/en/pharmacology/bupivacaine/)
- [Lidocaine](https://durgical.com/en/pharmacology/lidocaine/)

[← Back to the class: Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ROPIVACAINE HYDROCHLORIDE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e1d1b15-c224-4ff4-a39d-3b9cebfc8403) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 25 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01BB09) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/ropivacaine/
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