Ropivacaine

INTRODUCTION

Indications

Local or regional anesthesia for surgery. Acute pain management.

Action

Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission. Therapeutic Effects: Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Adverse Reactions/Side Effects

CNS: SEIZURES, anxiety, dizziness, headache, rigors. CV: CARDIOVASCULAR COLLAPSE, arrhythmias, bradycardia, chest pain, hypertension, hypotension, tachycardia. GI: nausea, vomiting. GU: urinary retention. Derm: pruritus. F and E: hypokalemia, metabolic acidosis. Hemat: anemia. Neuro: circumoral tingling/numbness, paresthesia. Resp: dyspnea. Misc: allergic reactions, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Monitor cardiac symptoms at rest and during exercise, and be alert for signs of severe cardiac insufficiency due to cardiac arrest (cardiovascular collapse). Seek immediate medical assistance if symptoms of cardiac arrest develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for other signs of systemic toxicity including anxiety, confusion, nervousness, tremor, headache, blurred or double vision, nausea, vomiting, slurred speech, ringing in ears, tremors, twitching, difficulty breathing, hypotension, severe dizziness or fainting, and unusually slow heart rate. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Monitor signs of allergic reactions, including pulmonary symptoms (laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Monitor signs of metabolic acidosis including headache, lethargy, stupor, seizures, vision disturbances, increased respiration, cardiac arrhythmias, weakness, and GI symptoms (nausea, vomiting, abdominal pain). Notify physician immediately if these signs occur.

• Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

• Assess signs of paresthesia (numbness, tingling) or numbness around the mouth. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess dizziness that might affect gait, balance, and other functional activities ...