Possible Interaction: Epinephrine and Ropivacaine

“ Ropivacaine with epinephrine injection for postoperative analgesia is not recommended for this patient population.”

“We conclude that epinephrine improves the pain relief and reduces the side effects of a thoracic epidural infusion of ropivacaine and fentanyl after major thoracic or upper abdominal surgery.”

“The addition of epinephrine to ropivacaine has not been recommended because ropivacaine has intrinsic vasoconstrictor properties.”

“We conclude that the addition of epinephrine 5 &mgr;g/mL to ropivacaine reduced the early systemic plasma concentrations of ropivacaine after epidural injection and may be useful for decreasing the risk of toxicity from systemic absorption of epidural ropivacaine.”

“ Ropivacaine plain had a significantly shorter duration of pulpal anesthesia than ropivacaine with epinephrine.”

“The combination of ropivacaine and adrenaline did not accentuate but instead diminished the vasoconstrictive effect of epinephrine.”

“We postulated that addition of epinephrine 5 microg.mL(-1) to epidural ropivacaine would improve efficacy, decrease systemic absorption and reduce neonatal effects.”

“CONCLUSIONS Adding ep nephrine to rop ivacaine in creases efficacy and duration of pQLB.”

“… ropivacaine … adrenaline group were significantly lower than the controls from 10 to 90 min (P < 0.003 for each comparison), and the Cmax was less than …/mL versus 1.99 μg/mL, P < 0.001) with a longer Tmax (103.5 min versus 51.0 min, P = 0.001).”

“The levels of epinephrine , norepinephrine, and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h (P < 0.01 for all).”

“Advanced age, malnutrition, epinephrine and possible elevation of α-1-acid glycoprotein levels could have altered the pharmacokinetics of plasma ropivacaine and possibly contributed to delayed neurotoxicity.”