Bupivacaine disposition in mother, fetus, and neonate after spinal anesthesia for cesarean section

Uptake of bupivacaine from the subarachnoid space and its placental transfer were measured in six patients undergoing elective cesarean section. Maternal plasma levels (59 +/- 32 ng/ml) were only about 5% of those found in a comparable previous study of epidural anesthesia. Mean plasma umbilical ven...

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Published inAnesthesia and analgesia Vol. 66; no. 5; pp. 407 - 412
Main Authors KUHNERT, B. R, ZUSPAN, K. J, KUHNERT, P. M, SYRACUSE, C. D, BROWN, D. E
Format Journal Article
LanguageEnglish
Published Hagerstown, MD Lippincott 01.05.1987
Subjects
Abdominal surgery. Urology. Gynecology. Obstetrics
Anesthesia
Anesthesia depending on type of surgery
Anesthesia, Obstetrical
Anesthesia, Spinal
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bupivacaine - administration & dosage
Bupivacaine - analysis
Bupivacaine - metabolism
Cesarean Section
Female
Fetal Blood - analysis
Fetus - metabolism
Humans
Infant, Newborn
Medical sciences
Pregnancy
Time Factors
Human
Regional anesthesia
Mother
Fetus
Obstetric
Pharmacokinetics
Intrathecal administration
Cesarean section
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Summary:Uptake of bupivacaine from the subarachnoid space and its placental transfer were measured in six patients undergoing elective cesarean section. Maternal plasma levels (59 +/- 32 ng/ml) were only about 5% of those found in a comparable previous study of epidural anesthesia. Mean plasma umbilical venous bupivacaine levels (20.2 +/- 21 ng/ml) were 7% of those found after epidural anesthesia. Mean umbilical venous/maternal venous bupivacaine ratios were 0.34 +/- 0.12 and mean umbilical arterial/umbilical venous ratios were 0.81 +/- 0.30. No bupivacaine was detectable in neonatal plasma 24 hr after delivery. Neonatal urine had measurable levels of both bupivacaine and its inactive metabolite, 2,6-pipecolylxylidine (PPX), for at least 36 hr after delivery. The results demonstrate that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts. This transplacental passage occurs despite injection of only small doses of a very highly protein bound drug into the subarachnoid space.
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ISSN:0003-2999
1526-7598
DOI:10.1213/00000539-198705000-00006