Local anesthetic cardiac toxicity can present as late-onset hypotension, bradycardia, and asystole.

We applaud Dr. Polley and Dr. Santos [1] for reminding us in their recent editorial of the potential risks of anesthetic toxicity in peripheral nerve block and of the need to employ standard safety methods to reduce the risk of cardiac toxicity in all forms of regional anesthesia. However, we believe their discussion missed another, equally important, lesson to be learned from these interesting case reports of ropivacaine-induced cardiac arrest.