Water-soluble drugs, such as rocuronium, will be distributed into a larger volume of distribution because of the volume-overloaded nature of many liver disease patients. This accounts for the need for a larger initial dose to obtain the desired clinical effect despite the prolonged duration of action.

Ester local anesthetics are metabolized by psuedocholinesterase and may have a prolonged duration of action. Amide local anesthetics are metabolized by the liver so they may also have a prolonged duration of action. With either class, care should be taken to avoid toxicity and large volume blocks probably should be approached with caution or avoided.