Ropivacaine

Chemical name

(S)-N-(2,6-Диметилфенил)-1-��ропил-2-пиперидинкарб оксамид

Gross

C17-H26-N2-O

Of drugs

The drugs - местноанестезирующее . Reversible potencialzawisimae blocks sodium channels from generating pulses per okonchaniah sensitive nerves and the nerve to fibres. If your system is the bloodstream dampening effect on the central nervous system and miocard (reduces anxiety and automaticity slows conductivity). The onset and duration of local anesthesia dependent on the introduction and dose and are, respectively : epiduralna in anaesthesia at the neck and torakalnom level 10-20 minutes and 3-5 hour (0.75% solution) or 4-6 hours (1% solution); in the wires and branches anaesthesia-min 1-15 and 2-6 h (0.75% solution); to blockade major nerve plexus (shoulder), 25 min and 10 h (0.75% solution). Analgezirutee up at epiduralnom introduction to the lumbar level (bolusnoe introduction) achieved in 10-15 min and remained 0.5-1.5 h, with wires and branches anaesthesia, after 1-5 minutes and lasts 2-6 h (0.2% solution). 150C distribution n-oktanol/fosfanetary buffer (pH 7.4), 141, pK_a - 8.1. The concentration of plasma depends on the dose, as a way of introduction and vascularization of injections. Completely absorbed from the epidural space, the absorption of the two-phase with T_1/2-14 min and 4 h, respectively. The plasma has been mainly associated with acid glikoproteinami. Plasma klirens-440 ml / min, the volume of 47 litres. Passes through GEB, placental barrier and enters breast milk (in small quantities). Biotransformiroetsa mainly through gidrauxilirovania, major metabolite - 3-gidrokshiropiwakain. Final T_1/2 1.8 hours About 86% of / in the imposed dose excreted in the urine as metabolites (73% kongugirovanny 3-gidrokshiropiwakain), and 1% in unaltered form.

Indications

Local anaesthesia : epiduralnaya, incl. kesarevom in section provodnikova (including major nerves and higher), infiltrazionnaya; mild acute pain syndrome (including postoperative pain and labor pain relief).

Restrictions on the use of

The blockade hearts (partial or total), cirrhosis, kidney failure.

Pregnancy and lactation

Be wary of pregnancy and breastfeeding (enters breast milk). Application for anesthesia or analgesia in obstetrics justified.

Contraindications

Hypersensitivity, age and 12 years of age (there is not sufficient number of clinical observations).

Side-Effects

Hypothesis or hypertension, or bradi- tachycardia, headache, dizziness, paresthesia, neiropatia violation of the spinal cord (syndrome front dorsal artery arahnoidit), nausea, vomiting, chills, increased body temperature, urine retention, allergic reactions (including anaphylactic shock).

Specific guidance

Prior to the start of the anesthesia should be established intravenous catheters and ensure that resuscitation equipment. Before and during the introduction (at the speed of 25 to 50 mg / min) to the test 2.17.1 (to prevent falling vnutrisosudistogo solution that can be recognized by an HR).

Patient interaction

Do toxic effect other local anesthetics and preparations for the structure similar to the local anaesthetics amide type. Do (mutually), the funds oppressive central nervous system.

Overdosing

Symptoms : impaired vision and hearing, gipotenzia, incredible, dizartria, increasing muscle strength, muscle bogies; Progressirovanii to intoxication : loss of consciousness, convulsions, hypoxia, gipercapnia, respiratory and metabolic acidosis, despnoe, patients, stopping Serdza.lechenie : an introduction, maintaining adequate oksigenation, mild convulsions and convulsing (nomination tiopentala 100-120 mg in / in or diazepam 10 mg in / in); If necessary, IVL (with the IVL typing suxamethonium), the normalization of blood, azidoza correction; in the development of hypotension and bradikardii Introduction ephedrine 5-10 mg in / in (possibly again in a couple of minutes).

Precautions

Patients with severe liver diseases to be reduced repeated doses. It should be borne in mind that ropiwakain violates mobility, coordination and speed of reaction. Therefore, after the application period of time, after which the patient can perform work that requires increased attention by Vrachom.pri a prolonged blockade (cefuroxim or re bolusnoe introduction) can be created toxic anestetika concentrations in the blood and the local nerve damage.

Dosing and Administration

0.2% solution. Severe acute pain syndrome : epidural introduction to neck level, a bolusnoe - 10-20 ml (20-40 mg); Intermittirutee introduction (pain during childbirth) for the 10-15 ml (20 mg) with a minimum interval of 30 minutes; Prolonged infusions for pain childbirth-6-10 ml / hour (12 to 20 mg / h); postoperative-a 6-14 ml / h (12-28 mg / h); epiduralnaya thoracic analgesia : prolonged infusions after operations are 6-14 ml / h (12-28 mg / h); provodnikova and infiltrazionnaya anaesthesia, 1-100 ml (2-200 mg) .0,75% solution. Anaesthesia with surgical interventions. Caesarean section is 15-20 ml (113-150 mg); Epiduralnaya thoracic anaesthesia in postoperative pain, 5-15 ml (38-113 mg); Epiduralnaya anaesthesia at the lumbar level, 15-25 ml (113-188 mg); Provodnikova and infiltration anaesthesia, 1-30 ml (mg 7,5-225); Blockade major nerve plexus (shoulder), 40 ml (75-300 mg) .1% solution. Anaesthesia with surgical interventions : epiduralnaya anaesthesia at the lumbar level, 15-20 ml (150 mg).

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