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Date: Tue, 13 Apr 1999 10:39:52 EDT
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Subject: (ARM) First study ever on epidural effects
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Standley K, Soule AB, Copans SA, Duchowny MS.  Local-Regional Anesthesia
during Childbirth:  Effect on Newborn Behaviors.  Science 1974;
186(4164):634-5.

Abstract:  Administration of local-regional anesthesia during normal
deliveries was correlated significantly with newborn behaviors as evaluated
by the Brazelton Neonatal Assessment Scale.  Three days after birth, infants
whose mothers received local-regional anesthesia were more irritable and
motorically less mature than those infants whose mothers were not medicated.

That same year, Scanlon (Scanlon JW, Brown WU, Weiss JB, Alper MH.
Anesthesiology 1974; 40:121.) found limited effects of epidural anesthesia on
newborn behavior after epidural but used a control group in which spinal
anesthesia, local anesthesia, and no anesthesia were all lumped together.
Nor was the effect of analgesic drug administration (narcotics) controlled
for.

Standley, et al.  found that local-regional anesthesia was correlated
significantly with decreased motor maturity and greater irritability.  Jerky
movements in small arcs, startles and tremulous motions, and frequent state
changes and crying were more common in babies of mothers who received
anesthesia.  Analgesia usage was signficantly related to lower scores on
motor maturity.

Medication effects were also correlated.  the most alert, least irritable,
and motorically most mature behaviors were shown by those babies whose
mothers had received no medication.  Anesthesia appeared to have more of an
impact on the infant than analgesia.  When the effect of analgesia was
controlled for by comparing babies whose mothers had received no analgesia,
the anesthesia and no anesthesia groups were significantly different on
irritability and motor maturity scores; the difference for alertness
approached significance.  On the other hand, when the effect of anesthesia
was controlled for by comparing the four groups of babies whose mothers
received anesthesia and varying doses of analgesia,  no signficant
differences were found on the infant measures.  Product-moment correlations
between analgesia and the three BNBAS clusters were nonsignficant when only
those subjects who received anesthesia were included in the analysis.

The three Brazelton clusters did not correlate significantly with other
factors related to the difficulty of delivery: length of labor, use of
forceps (in the anesthetized group), Apgar scores, and infant birth weight.

The study was conducted on 60 first-born, full-term, healthy infants between
48 and 72 hours of age.  All were born of white, middle-class women who had
received routine antenatal care and had medically uneventful pregnancies and
deliveries.

The authors responded to criticism from the anesthesiology community
(Hodgkinson R, Marx GF.  Local-regional anesthesia during childbirth and
newborn behavior.  Science 1974; 189(4202):571-2.).  The critics could not
believe the results because of lack of biochemical explanation.  At that
time, it was not known that epidural anesthetics reached the fetal
circulation.  The authors responded well to the small sample criticism, as
well (Standley K, Klein RP, Soule AB., same reference):

They said, "We, too, wish that this group was larger; however, the small
sample size works against finding significant differences because it reduces
the power of the statistical tests (Cohen J.  Statistical Power Analysis for
the Behavioral Sciences.  New York: Academic Press, 1969, pp 1-16)."  The
authors argued for larger studies, as everyone today should still continue to
do.





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