Fetal Diagn Ther 2005;20:208–213 DOI: 10.1159/000083907 Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation? D. Strümper a F. Louwen c M.E. Durieux d H.F. Gramke e J. Stuessel b D. Marcus-Soekarman f H. Van Aken a M.A.E. Marcus e Departments of a Anesthesiology and Intensive Care Medicine, b Obstetrics and Gynecology, University of Münster, and c Obstetrics and Gynecology, University of Frankfurt, Germany; d Anesthesiology, University of Virginia, Va., USA; e Anesthesiology, Pain Therapy and Home Ventilation, and f Genetics, University Hospital Maastricht, The Netherlands tored by Doppler sonography and the amount of amni- otic fluid was estimated daily. Results: Epidural insertion and infusion was performed without complications. Four patients continued to deteriorate rapidly, amniotic fluid volume did not change and uterine artery pulsatility in- dex (PI) tended to increase. In the remaining 6 patients the clinical status stabilized, amniotic fluid volume tend- ed to increase and uterine artery PI tended to decrease during treatment. This improvement was associated with a prolonged interval to cesarean section and in- creased infant birth weight. Conclusion: Our data sug- gest that, even if the underlying cause of IUGR is not pre-eclampsia, epidural local anesthetic administration might improve placental blood flow and be beneficial in a subgroup of patients. A clinical trial to test this hypoth- esis appears warranted. Copyright © 2005 S. Karger AG, Basel Introduction Adequate uteroplacental circulation is essential for normal intrauterine development of the fetus. When uteroplacental circulation is chronically compromised, Key Words Intrauterine growth restriction  Epidural  Local anesthetics Abstract Background: Chronically compromised uterine perfu- sion may lead to placental insufficiency and subsequent intrauterine growth restriction (IUGR). Various therapeu- tic approaches (e.g. vasodilators, low-dose aspirin, intra- venous glucose infusion, and hemodilution) are often of limited efficacy. Local anesthetics have been shown to improve placental blood flow in pre-eclamptic women. We hypothesized that epidural administration of local anesthetics might improve outcome in IUGR indepen- dent of the underlying cause. In preparation for a clinical trial to test this hypothesis, we performed a pilot study in 10 patients. Methods: After approval of the study pro- tocol, 10 pregnant women presenting with oligohydram- nios and IUGR were included in the study. In addition to our standard protocol (magnesium, glucose, betametha- sone), each patient received an epidural catheter (T10/ T12) with continuous infusion of bupivacaine 0.175% at a rate of 5 ml/h. Uteroplacental circulation was moni- Received: November 27, 2003 Accepted after revision: April 7, 2004 Marco Marcus, MD, PhD Department of Anesthesiology, Pain Therapy and Home Ventilation University Hospital Maastricht, P. Debyelaan 25 NL–6202 AZ Maastricht (The Netherlands) Tel. +31 43 3877457, Fax +31 43 3875457, E-Mail mmar@sane.azm.nl © 2005 S. Karger AG, Basel 1015–3837/05/0203–0208$22.00/0 Accessible online at: www.karger.com/fdt Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Downloaded by: Universiteit Maastricht 137.120.4.50 - 1/22/2015 9:24:51 PM