The influence of maternal analgesia on neonatal behaviour: II. Epidural bupivacaine

Abstract

Four areas of neonatal behaviour have been assessed at delivery and during the following six weeks in a group of infants whose mothers were given epidural bupivacaine during labour. The influence on such a behaviour of the total maternal dose of bupivacaine and umbilical cord blood concentration of the drug has been examined with the confounding effects of other maternal and obstetric variables controlled. Significant and consistent effects of bupivacaine throughout the assessment period can be demonstrated. Immediately after delivery, infants with greater exposure to bupivacaine in utero were more likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly with increases in the cord blood concentration of bupivacaine, particularly on the first day of life by also throughout the next six weeks. Adverse effects of bupivacaine levels on the infant's motor organisation, his ability to control his own state of consciousness and his physiological response to stress were also observed. Muscle tone alone appeared to improve with increases in the values of the drug variables. These results show that the neonate differs from the adult in respect of both the nature of effects of the drug and sensitivity to it.