title: The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine.
abstract: OBJECTIVE
  Ropivacaine and levobupivacaine were developed after evidence of bupivacaine-related severe toxicity. Despite a comparable analgesic profile, quantitative differences become evident with regard to their specific rate of systemic toxicity. The present article provides a concise review of the toxic potencies of levobupivacaine and ropivacaine.
  
  
  RESULTS
  As lipophilicity is known to be a major determinant in local anesthetic toxicity, the clinical safety profile of ropivacaine seems to be more favorable than that of levobupivacaine. Experimental studies and case reports confirm this hypothesis, showing that ropivacaine is characterized by fewer (cardio) toxic effects and, most probably, a greater margin of safety. Both agents also may dose dependently damage neurons and skeletal muscle tissue at the injection site. Although their specific rate of neurotoxicity appears to be rather low, levobupivacaine is characterized by an outstanding myotoxic potential.
  
  
  CONCLUSIONS
  Compared with bupivacaine, both agents may be considered as 'more well tolerated' but not as 'totally well tolerated', as they are still capable of inducing systemic and local toxicity. However, ropivacaine seems to have the greatest margin of safety of all long-acting local anesthetics at present.
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Goettingen, Goettingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zink
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Graf
mesh_terms: D000577:Amides / Q000009:adverse effects* / Q000494:pharmacology; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects* / Q000494:pharmacology; D002045:Bupivacaine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D006801:Humans; D000077554:Levobupivacaine; D000077212:Ropivacaine; D013810:Therapeutic Equivalency
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine