The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used for pudendal block.

The neonatal neurobehavioral effects of bupivacaine, mepivacaine, and 2-chloroprocaine used in random sequence for pudendal block anesthesia were studied. The neurobehavioral status of 54 infants was studied 4 and 24 hours after delivery. Except for a significant difference in the responses to pinprick, there was no significant effect of any of these agents on infant neurobehavior, and no differences were found among the agents themselves. Mean mepivacaine levels in neonatal capillary blood at 4 hours of age were low (0.10 +/- .02 microgram/ml) compared with those in previous studies because of the short interval between maternal injection and delivery (13 +/- 3 min). Bupivacaine gave higher neonatal capillary blood levels (0.15 microgram/ml at 4 hours of age) than previously reported, but the drug still produced no detectable neonatal neurobehavioral effects.