Ropivacaine cardiac toxicity — not as troublesome as bupivacaine

Abstract

In summary, initial reports about bupivacaine induced cardiac toxicity were slow to emerge, as were those associated with ropivacaine. It is comforting to note that ropivacaine induced cardiac toxicity is far more readily treatable. Single shot epidural injections of high concentrations of bupivacaine in obstetric patients were responsible for a number of deaths in the past. Let us not make the same mistake with peripheral nerve blocks. Even though the majority of serious toxic reactions to local anesthetics occur following accidental intravascular injections, some occur because the recommended dose limits are exceeded. Therefore we should adhere to the dosage guidelines. Small incremental doses (no more than 5 mL at a time) of local anesthetic are recommended. Add a vascular marker to the local anesthetic and maintain verbal contact with the patient at all times. Finally, ECG monitoring is essential when performing regional anesthesia.