Epidural ropivacaine hydrochloride during labour: Protein binding, placental transfer and neonatal outcome

This study was undertaken: (i) to quantify the effects of labour and epidural analgesia on plasma α1-acid glycoprotein concentration, (ii) to examine the effects of changes in plasma α1-acid glycoprotein concentration on plasma protein binding and placental transfer of ropivacaine, and (iii) to examine the association between umibilical venous ropivacaine concentration and neurobehavioural function in the neonate. Multiparous patients undergoing induction of labour received a continuous epidural infusion of 0.1% ropivacaine following an epidural bolus. A significant association was demonstrated between maternal plasma α1-acid glycoprotein concentration and 1/free fraction of ropivacaine 60 min after starting ropivacaine administration (r2 = 0.77) but not at delivery. No significant correlation was demonstrable between maternal unbound ropivacaine concentration and either neonatal (cord) ropivacaine cocentration or UV/MV (a measure of placental transfer). Thirty minutes after delivery, 9/10 neonates and neurological and adaptive capacity scores < 35, whereas only three infants had scores < 35 at 2 h. All scores exceeded 35 16 h after delivery. No association between mean (SD) umbilical venous ropivacaine concentration [0.09 (0.08) mg.l-1] and neurological and adaptive capacity scores was demonstrated.