From the FDA Drug Label
The doses in the table are those considered to be necessary to produce a successful block and should be regarded as guidelines for use in adults. Experience to date indicates that a cumulative dose of up to 770 mg Ropivacaine Hydrochloride administered over 24 hours is well tolerated in adults when used for postoperative pain management: i.e., 2016 mg.
The maximum per kg dose of ropivacaine for epidural administration in adults is not directly stated in the drug label. However, based on the information provided, the cumulative dose of up to 770 mg over 24 hours can be used as a guideline. To determine the maximum per kg dose, we need to know the patient's weight. Since this information is not provided, we cannot calculate the maximum per kg dose. 1
From the Research
The maximum recommended dose of ropivacaine for epidural administration in adults is 3 mg/kg body weight. This dose should not be exceeded within a 4-hour period to minimize the risk of local anesthetic systemic toxicity. When administering ropivacaine epidurally, the dose should be given incrementally (typically 3-5 mL at a time) with careful aspiration before each injection to avoid intravascular administration. Patients should be monitored for signs of local anesthetic systemic toxicity, including perioral numbness, metallic taste, tinnitus, confusion, seizures, or cardiovascular depression. Some key points to consider when using ropivacaine for epidural administration include:
- Concentrations of 0.5% to 1.0% ropivacaine are commonly used, with total volumes ranging from 15-25 mL depending on the desired level of block 2.
- The addition of epinephrine to ropivacaine may reduce the early systemic plasma concentrations of ropivacaine and decrease the risk of toxicity from systemic absorption of epidural ropivacaine 3.
- Ropivacaine has a better safety profile than bupivacaine regarding cardiotoxicity, which makes it preferred in many clinical scenarios.
- The onset of epidural anesthesia with ropivacaine typically occurs within 10-20 minutes, with a duration of action of approximately 4-6 hours depending on the concentration used and whether epinephrine is added to the solution. It's also important to note that the quality of analgesia can be improved by the addition of fentanyl to ropivacaine, as shown in a study where the combination of 0.1% ropivacaine and 1 microg/mL fentanyl provided better pain relief than 0.1% ropivacaine alone 4.