LipidRescue™ Resuscitation

There is controversy on this point. Most people believe that ropivacaine is less cardiotoxic than bupivacaine on a mg/mg basis. However, it is also widely believed that since ropivacaine is less potent than bupivacaine, that on an equipotent basis, the toxicities are equal. I am in this camp. Also note that regardless of what LA you use, there is sufficient inter patient variability in sensitivity to LA toxiciity that some patients will get into trouble even at low doses of either LA. Contrary to what you'll read (or not read) in the literature, ropivacaine can cause fatal cardiac arrest...this is incontrovertible. NOte that bupivacaine is still the most widely used long acting LA; it is even used at sites like HSS that are centers of excellence in regional anesthesia. whatever you choose, be prepared for severe toxicity even while you practice with flawless regional anesthesia/pain medicine technique.
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