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Local anesthetics are routinely used in the field of medicine during many procedures, to alleviate acute pain. Although they are relatively safe, they have the ability to produce undesirable neurotoxic and cardiotoxic symptoms when administered intravascularly. Examples of cardiotoxicity include myocardial depression, cardiac arrhythmias, and cardiovascular collapse. The case below describes the adverse events of severe bradycardia, PR prolongation with subsequent heart block, and sinus arrest following an elective knee replacement in a 73-year-old male who received bupivacaine and ropivacaine.

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