ropivacaine + epinephrine + ketorolac + clonidine

A fixed-dose combination of four active pharmaceutical ingredients—ropivacaine (a long-acting amide local anesthetic), epinephrine (a vasoconstrictor), ketorolac (a nonsteroidal anti-inflammatory drug), and clonidine (an alpha-2 adrenergic agonist)—formulated as a ready-to-use injectable solution for periarticular or local infiltration. This multimodal, opioid-sparing analgesic cocktail is used primarily for postoperative pain management in orthopedic and spine surgeries such as lumbar decompression, laminectomy, diskectomy, and arthroplasty. - **Ropivacaine** blocks voltage-gated sodium channels on neuronal membranes to inhibit nerve impulse transmission and provide regional anesthesia. - **Epinephrine** induces vasoconstriction at the injection site to prolong anesthetic effect by reducing systemic absorption of ropivacaine. - **Ketorolac** inhibits cyclooxygenase enzymes (COX-1/COX-2) to reduce prostaglandin synthesis and inflammation-related pain. - **Clonidine** acts on alpha-2 adrenergic receptors to enhance analgesia via both central and peripheral mechanisms; it also prolongs nerve blockade duration when combined with local anesthetics[1][4][6][7]. The combination has demonstrated efficacy in reducing postoperative opioid consumption, lowering pain scores, shortening hospital stays after surgery, and facilitating earlier mobility[1][4][6]. It is available as a patented ready-to-administer formulation under the name R.E.C.K.[2].

Brand names

R.E.C.K.

Other names

ropivacaine-epinephrine-clonidine-ketorolac cocktailRECK cocktail