the notable exception is bupivacaine, which is associated with the development of neurotoxicity and cardiotoxicity at virtually identical levels. Because of this risk of systemic toxicity, use of 0.75 percent solution of bupivacaine for epidural injection was proscribed by the food and drug administration in 1984. Similar to neurotoxicity, cardiovascular toxicity is characterized first by stimulation and then by depression. Accordingly, there is hypertension and tachycardia, which soon is followed by hypotension, cardiac arrhythmias, and impaired uteroplacental perfusion