Ropivacaine is too expensive to merit its routine use in epidural labor analgesia, especially when bupivacaine is more potent, much cheaper, and no different with respect to toxicity or maternal or neonatal outcomes. In addition, the clinical preparations of ropivacaine in glass bottles and hard plastic vials severely limit the flexibility of concentrations and opioid additives that can be prepared for epidural infusions, whereas concentrated bupivacaine preparations in stoppered glass vials allow dilutions to an infinite spectrum of concentrations and additives. Bupivacaine is a long-acting local anesthetic no longer under patent protection that has a long history of safe use in epidural anesthesia for both obstetric labor anesthesia and for intraoperative anesthesia and postoperative analgesia for a wide variety of cardiac, thoracic, orthopedic, and general abdominal surgeries. Like all local anesthetics, excess administration intravenously may produce neurotoxicity and cardiotoxicity. The refractory nature of racemic bupivacaine cardiotoxicity led to the separation and clinical testing of its L-enantiomer, ropivacaine. Unfortunately, this research was biased by funding sources, and led to the misleading conclusion that ropivacaine was safer than bupivacaine. Drs Beilin and Halpern review some of the main comparative studies and conclude that no significant difference exists. I have long argued that the studies lack clinical relevance because they compared equal concentrations of ropivacaine and bupivacaine administered intravenously to volunteers, when epidural ropivacaine is routinely used at a significantly higher concentration (0.2%) than epidural bupivacaine (0.0625-0.125%). In these routine clinical circumstances, ropivacaine would be more likely to cause toxicity than bupivacaine, and review of recent case reports supports this hypothesis. Furthermore, the use of intravenous intralipid as an antidote to bupivacaine cardiotoxicity has further enhanced its safety profile. Ropivacaine is popular because it is new and touted as better and safer, but because it is under patent protection it is much more expensive than bupivacaine, without any significant added benefit or decreased risk. If ropivacaine is the great new local anesthetic, then why not advocate its use in epidural anesthesia for cesarean delivery as well as for labor analgesia? I only had to use it once to understand why. My patient was completely comfortable during testing and initial skin incision but the obstetrician would not proceed further because the patient kept moving her legs up and down during the surgery. Lack of significant motor blockade with epidural ropivacaine has never been shown to translate into a greater incidence of vaginal delivery compared to bupivacaine, yet an immobile surgical field is a nearly absolute requirement for obstetricians performing cesarean delivery. I am delighted that Dr Beilin and Dr Halpern advocate the use of epidural bupivacaine over ropivacaine because it concurs with both my review of the literature and my clinical experiences.