Q: How does NAROPIN compare with bupivacaine in terms of motor function?
Q: How does NAROPIN compare with bupivacaine for labor epidurals?
Q: How does NAROPIN compare with bupivacaine in terms of analgesia?
Q: What are the key safety advantages of NAROPIN compared with bupivacaine?
Q: What are common (≥5%) side effects reported when using NAROPIN?
Q: What concentrations of NAROPIN are available?
Q: What are the advantages of infusion bottles?
Q: What are Polyamp DuoFit® ampules?
Q: How does NAROPIN's pharmacologic profile differ from that of bupivacaine?
Q: How does NAROPIN compare with bupivacaine in terms of motor function?
A: At equivalent concentrations of 0.5%, NAROPIN offers faster return of motor function postoperatively following upper and lower body surgical procedures than bupivacaine.
Return of motor function - NAROPIN vs. bupivacaine at 0.5%:
- 8-10 hours faster in patients having undergone total knee arthroplasty (combined sciatic-femoral nerve block)1
- 9.6 hours faster at the wrist and 5.6 hours faster at the hand in patients having undergone elective surgery on the lower arm (axillary brachial plexus block)2
- 66 minutes faster in patients having undergone lower extremity surgery (epidural block)3
- 72 minutes faster in patients having undergone a C-section (epidural block)4
In a comparative study examining the prevention of postoperative pain after a 24-hour infusion at 0.2% following total knee arthroplasty, patients receiving NAROPIN had significantly less frequent and less intense motor block.5 Specifically, 88% of patients receiving NAROPIN were free from motor block after 24 hours of continuous infusion compared with only 56% of patients receiving bupivacaine.5
Q: How does NAROPIN compare with bupivacaine for labor epidurals?
A: NAROPIN delivers a less intense motor block enabling greater active maternal participation during delivery.6 At 10 hours, patients given 0.2% NAROPIN and 0.3% NAROPIN had 42% and 40% isometric muscle force (IMF) respectively compared to 2% for patients given 0.25% bupivacaine.7
Q: How does NAROPIN compare with bupivacaine in terms of analgesia?
A: NAROPIN delivers better pain relief as measured by less supplemental opioids needed 10 hours post-op following sciatic-femoral block for total knee replacement.1
- NAROPIN patients experienced significantly less "at rest" and "on movement" post-op pain for the first 10 hours (P<0.05)1
- NAROPIN patients needed less morphine to achieve initial effective analgesia post-operatively1
- 93% of NAROPIN patients rated their analgesia as "excellent" versus only 73% of bupivacaine patients (P<0.05)1
Q: What are the key safety advantages of NAROPIN compared with bupivacaine?
A: The most serious safety concerns surrounding the use of local anesthetics involve the cardiovascular and central nervous system. Based on clinical pharmacologic studies, NAROPIN has less risk of cardiotoxicity – i.e., significantly less depression of cardiac conductivity (less QRS widening) – as compared to bupivacaine. This cardiovascular depression profile provides an advantage in the event that an inadvertent intravascular injection occurs.8,9
NAROPIN also provides faster recovery from CNS symptoms (e.g, visual and hearing disturbances and tingling) versus bupivacaine in IV toxicity studies. Recovery from CNS symptoms was 7 minutes shorter with NAROPIN than with bupivacaine (13 min vs. 20 min, P<.05, N=12).9
Q: What are common (≥5%) side effects reported when using NAROPIN?
A: Like all amide-type anesthetics, NAROPIN may be associated with adverse reactions. In clinical trials, side effects were mild and transient and may reflect the procedures, patient health status, and/or other medications used. Adverse events reported at a rate of ≥5%: hypotension, nausea, vomiting, bradycardia, fever, pain, postoperative complications, anemia, parasthesia, headache, pruritis, and back pain.10
Q: What are the recommended concentration, dose, and infusion rates of NAROPIN for its indicated uses?
A: Please see dosing card below.
To enlarge image, please click on dosing card below.
Q: What concentrations of NAROPIN are available?
A: The following concentrations of NAROPIN are available:
• 2.0 mg/mL (0.2%)
• 5.0 mg/mL (0.5%)
• 10.0 mg/mL (1.0%)
Solutions of NAROPIN are available in a range of dosage forms:
• Single-dose vials• Sterile-Pak
• Polyamp DuoFit® ampules
• Infusion bottles
Q: What are the advantages of infusion bottles?
A: Infusion bottles are ideal for prolonged administration, making them convenient and cost-effective for postoperative pain management and labor pain management. They reduce the errors associated with dosing and premixing. Since mixing is not required, they also save time and labor costs and ensure that sterility is maintained throughout use.
Q: What are Polyamp DuoFit® ampules?
A: Polyamp DuoFit® are polypropylene ampules that are designed for needle-free draw up, offering protection from glass shards, needles, and latex. The easy twist-off cap prevents cuts from sharp bands found on vials. Polyamp DuoFit® ampules are compatible with Luer-Lok® and tapered syringes and are available in individual Sterile-Pak outer packaging. The Sterile-Pak enables Polyamp DuoFit® to be placed directly into the sterile field.
Luer-Lok® is a registered trademark of Becton, Dickinson and Company.
Q: How does NAROPIN's pharmacologic profile differ from that of bupivacaine?
A: Unlike bupivacaine, the low lipid-solubility of NAROPIN makes it more selective for C sensory fibers than for A motor fibers.11 Consequently, NAROPIN offers a similar sensory blockade but a shorter motor blockade.11
REFERENCES
1. Beaulieu P, Babin D, Hemmerling T. The pharmacodynamics of ropivacaine and bupivacaine in combined sciatic and femoral nerve blocks for total knee arthroplasty. Anesth Analg. 2006;103:768-774.
2. McGlade D, Kalpokas M, Mooney P, Chamley D, Mark A, Torda T. A Comparison of 0.5% ropivacaine and 0.5% bupivacaine for axillary brachial plexus anesthesia. Anaesth Intensive Care. 1998;26:515-520.
3. Morrison LM, Emanuelsson BM, McClure JH, Pollok AJ, McKeown DW, Brockway M, et al. Efficacy and kinetics of extradural ropivacaine: comparison with bupivacaine. Br J Anaesth. 1994;72:164-169.
4. Griffin RP, Reynolds F. Extradural anaesthesia for caesarean section: a double-blind comparison of 0.5% ropivacaine with 0.5% bupivacaine. Br J Anaesth. 1995;74:512-516.
5. Muldoon T, Milligan K, Quinn P, Connolly DC, Nilsson K. Comparison between extradural infusion of ropivacaine or bupivacaine for the prevention of postoperative pain after major orthopedic surgery. Br J Anesth. 1998;80:680-681.
6. McClure JH. Ropivacaine. Br Journal of Anesthesia 1996;300-307
7. Zaric D, Nydahl P-A, Phillipson L, Samuelsson L, Heierson A, Axelsson K. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers: a double-blind study. Reg Anesth. 1996;21:14-25.
8. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-569.
9. Knudsen K, Beckman Suurküla M, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-514.
10. NAROPIN Package Insert.
11. Hansen T. Ropivacaine: a pharmacological review. Expert Review of Neurotherapeutics. 2004;4:781-791.
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Using NAROPIN® beyond recommended doses to increase motor block or duration of sensory block may negate its favorable cardiovascular advantages, in the event that an inadvertent intravascular injection occurs.
Like all amide-type local anesthetics, NAROPIN® may be associated with adverse reactions. In clinical trials, side effects were mild and transient and may reflect the procedures, patient health status, and/or other medications used. Adverse events reported at a rate of ≥5%: hypotension, nausea, vomiting, bradycardia, fever, pain, postoperative complications, anemia, paresthesia, headache, pruritus, and back pain.
