Dosage et présentation de la ropivacaîne
Dosage et présentation (tableaux III, IV)
Doses recommandées
Pour l’anesthésie péridurale, les doses recommandées se situent entre 113 et 200 mg. Ces doses sont obtenues en faisant varier soit la concentration soit le volume de la solution.
Pour l’analgésie péridurale postopératoire, la ropivacaïne est administrée soit sous forme de bolus de 20 à 40 mg, suivis de doses de complément de 20 à 30 mg à des intervalles de plus de 30 minutes, soit sous forme d’une perfusion continue à la concentration de 0,2 %, à un débit variant de 6 à 14 mL/h par voie lombaire et de 4 à 8 mL/h par voie thoracique.
L’administration périphérique continue par cathéter tronculaire ou plexulaire semble prometteuse, mais n’a encore fait l’objet que de peu de travaux contrôlés. L’infiltration des plaies opératoires, réalisée avant, pendant ou après la chirurgie, paraît également très efficace en termes d’analgésie. Les doses proposées varient de 100 à 300 mg.
Présentations
La ropivacaïne (Naropeinet) est disponible en solutions concentrées à 0,2 %(2 mg/mL), 0,75 %(7,5 mg/mL) et 1 %(10 mg/mL), sous forme d’ampoules de polypropylène de 10 et 20 mL, présentées en barquette stérile. Ce produit est également proposé en poches de polypropylène de 100 et 200 mL, concentrées à 0,2 %. Cette présentation, jusque-là inédite, facilite donc l’utilisation sur le mode continu, actuellement réservé à la voie péridurale.
Ces solutions ne contiennent pas de conservateurs et sont destinées à l’usage unique. La ropivacaïne ne doit pas être mélangée ou diluée avec d’autres solutions, une précipitation pouvant survenir dans les solutions alcalines en raison de la faible solubilité de la ropivacaïne à pHsupérieur à 6.
La durée de conservation est de 2 ans pour les solutions en poche et de 3 ans pour les solutions en ampoule, à une température de conservation comprise entre 15 et 30 °C.
Au plan expérimental, les travaux les plus récents confirment la cardiotoxicité moindre de la ropivacaïne par comparaison à la bupivacaïne. Sur la base des données cliniques actuellement disponibles, la ropivacaïne apparaît aussi efficace et aussi bien tolérée que la bupivacaïne à doses équianalgésiques. Par comparaison à la bupivacaïne, le bloc différentiel sensitivomoteur n’est patent qu’aux concentrations intermédiaires.
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