Table
1: Comparison between Bupivacaine and Ropivacaine
Bupivacaine
|
Ropivacaine
|
|
Description
[1]
|
Amide
|
Amide
|
Relative
Potency [1]
|
8
|
6
|
Onset
[1]
|
10 – 15 mins
|
10 – 15 mins
|
Duration
[1]
(without Epinephrine) |
3 – 12 h
|
3 – 12 h
|
Duration
[1]
(with
Epinephrine)
|
4 – 12 h
|
4 – 12 h
|
Maximum
dose [1]
(without
Epinephrine)
|
2.0 mg/kg
|
3.0 mg/kg
|
Maximum
dose [1]
(with
Epinephrine)
|
2.5 mg/kg
|
4.0 mg/kg
|
ADRs
|
More
cardiotoxic [1] (hypotension & bradycardia) [2]
GI
disorders: nausea, vomiting, Renal & urinary disorders (retention or
incontinence), postdural puncture headache. [2]
|
Less
cardiotoxic with better safety margin. [1]
Vascular
disorder (hypotension), nausea, vomiting, urinary retention, hyperthermia,
rigor, backpain, hypertension, bradycardia, tachycardia, paraesthesia,
dizziness, headache. [4]
|
Pharmacokinetics
|
Muscular
relaxation of lower extremities last 2-2.5 h.
Blockage
of abdominal muscle lasts 45- 60 mins. [3]
|
Exhibits
complete & biphasic absorption from epidural space with half lives of the
two phases of the order as 14 mins and 4 h for adults.
Renal
Cl: 1 ml/min
Total
plasma clearance: 440 ml/min
Vd:
47 L, Terminal half life: 1.8 h after IV
Excretion:
86% urine
Slow
absorption is the rate limiting factor which explains why the apparent elimination
half life is longer after epidural than after IV administration. [4]
|
Pharmacodynamics
|
Long
acting with moderate muscular relaxation of lower extremities. Allows motor
blockade of the abdominal muscles. Bupivacaine heavy is hyperbaric and its initial
spread in the intrathecal space is affected by gravity. [3]
|
Has
anaesthetic and analgesic activity.
At
high doses: surgical anaesthesia
Lower
dose: sensory block with limited and non-progressive motor block. [4]
|
Storage
|
Do not store above 250C
for unopened vial [3]
|
Do not store above 30 o C.
Do not freeze
|
Stability
|
Discard unused solution [3]
|
Discard any unused solution [4]
|
Incompatibilities
|
N/A
|
Precipitates in alkaline solution
with pH>6 [4]
|
- http://www.frca.co.uk/article.aspx?articleid=100816
- http://e-safe-anaesthesia.org/e_library/09/Subarachnoid_Block_TOTW_059_2007.pdf
- https://www.medicines.org.uk/emc/medicine/185#EXCIPIENTS
- https://www.medicines.org.uk/emc/medicine/7290
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