A 5-week-old preterm infant was scheduled for inguinal hernia repair. Following induction of general anaesthesia, 10 mg.kg−1 ropivacaine was injected, accidently, into the caudal space. The infant developed cardiac depression with bradycardia (minimum heart rate 50 beats.min−1), elevated T waves and widening of QRS complexes. Resuscitation by means of external chest compression, intravenous adrenaline and fluid administration was successful. Ropivacaine serum concentrations were obtained at three time points yielding a peak level of 6 μg.ml−1 20 min after caudal injection.