The effects of pregnancy on the systemic toxicity of local anesthetics have been controversial. A recent study performed on sheep demonstrates that pregnancy does not enhance the toxicity of bupivacaine or ropivacaine, a new amide local anesthetic. Two investigations pertaining to cocaine conclude that cardiovascular pertubations resulting from the drug are greater during pregnancy and that the placental transfer of the drug occurs rapidly. The pharmokinetics of bupivacaine were studied in parturients after intrathecal and epidural administration. The long elimination half-life and high blood level noted after epidural injection reinforces the fact that patients on continuous infusions require vigilance for signs and symptoms of systemic toxicity. The safety of breast feeding after a clinical exposure to local anesthetic agents is reinforced in a recent review, and the authors of another study concluded that local anesthetics do not adeversely affect uterine blood flow or fetal wellbeing. However, some authors cautioned against the addition of epinephrine to local anesthetics used for epidural anestheisa in the setting of asphyxia. Lastly, the usefulness of warming local anesthetic solutions and the volume that patients on pre-existing continuous epidural infusions require for cesarean section are discussed.