What is the dose limit for ropivicaine (local anesthetic)?

Ropivacaine Dose Limits

The maximum safe dose of ropivacaine 0.2% is 3 mg/kg (equivalent to 1.5 mL/kg) for wound infiltration and peripheral nerve blocks in pediatric patients. 1

Maximum Dose by Concentration and Route

For Peripheral Nerve Blocks and Wound Infiltration

• Ropivacaine 0.2%: Maximum dose is 3 mg/kg (1.5 mL/kg) 1
• This is the most commonly cited maximum dose across multiple regional anesthesia techniques in the 2024 European Society for Paediatric Anaesthesiology guidelines 1

Volume-Based Dosing by Block Type (using 0.2% ropivacaine)

The following volumes apply when using 0.2% ropivacaine concentration:

Smaller Volume Blocks:

• Maxillary and external nasal nerve blocks: 0.15 mL/kg 1
• Intercostal blocks: 0.1 mL/kg 1

Intermediate Volume Blocks:

• Thoracic epidural: 0.2-0.3 mL/kg 1
• Paravertebral blocks: 0.2-0.5 mL/kg 1
• Femoral nerve and fascia iliaca blocks: 0.2-0.5 mL/kg 1
• Rectus sheath and TAP blocks: 0.2-0.5 mL/kg per side 1

Larger Volume Blocks:

• Lumbar epidural: 0.5 mL/kg (maximum 15 mL initially) 1
• Caudal block: 1.0 mL/kg 1

Continuous Infusions

• Ropivacaine 0.2%: 0.1-0.3 mL/kg/h for continuous regional anesthesia 1
• This requires adequate monitoring according to institutional standards 1

Adult Dosing Considerations

Local Infiltration

• Maximum dose for local infiltration: 200 mg (using concentrations up to 0.5%) 2
• Time to first analgesic request ranges from 2-6 hours with 100-200 mg doses 2

Plasma Concentration Safety Data

• Peak plasma concentrations after epidural dosing of 120-200 mg occur at approximately 20 minutes (range 10-30 min) 3
• Mean peak concentration: 1.38 ± 0.42 mcg/mL (range 0.95-2.26 mcg/mL) 3
• Toxic threshold for CNS effects: Free plasma concentrations approaching this threshold may occur with doses ≥300 mg for brachial plexus block 2
• Research shows peak concentrations of 2.5 mcg/mL after axillary block with 5 mg/kg (highest individual 4.2 mcg/mL) without toxic reactions 4

Critical Safety Considerations

Important Caveats:

• The 3 mg/kg maximum dose (1.5 mL/kg of 0.2%) should not be exceeded to avoid systemic toxicity 1
• For doses >300 mg in adults, terminal half-life may be prolonged (>30 hours) 2
• Always calculate total dose in mg/kg, not just volume, as concentrations vary 1
• Ropivacaine shows dose-proportionality up to 80 mg IV 2

Comparison to Bupivacaine:

• Ropivacaine 0.2% at 3 mg/kg provides a higher maximum dose than bupivacaine 0.25% at 2.5 mg/kg 1, 5
• This makes ropivacaine advantageous for larger volume blocks where the 3 mg/kg limit allows more extensive coverage 1