Eighteen milligrams of 0.5% hyperbaric ropivacaine provided effective spinal anesthesia with shorter duration of sensory and motor block, compared with 12mg of 0.5% hyperbaric bupivacaine when administered for cesarean delivery.

Intrathecal (i.t.) neostigmine 25 microg produced postoperative analgesia for cesarean section similar to that of i.t. morphine 100 microg, but with a high incidence of nausea and vomiting. The combination of i.t. neostigmine 12.5 microg and i.t. morphine 50 microg may produce better postoperative analgesia with fewer side effects than i.t. neostigmine 25 microg or i.t. morphine 100 microg alone.

To investigate the safety and efficacy of 0.25% hyperbaric bupivacaine for spinal anaesthesia in Caesarean section, we studied 60 parturients allocated randomly to one of three groups. According to the patient's height, groups 1, 2 and 3 received 3.2-3.6 ml (8-9 mg), 3.6-4.0 ml (9-10 mg) and 4.0-4.4 ml (10-11 mg) of 0.25% bupivacaine in 5% glucose, respectively. Subarachnoid injection was performed in the right lateral decubitus position, and parturients were then turned immediately supine with left uterine displacement. Mean spread of sensory analgesia was significantly higher in group 3 (T2-3) than in groups 1 and 2 (T4-5 in each group). Duration of sensory analgesia was significantly longer in groups 2 and 3 than in group 1. Complete motor block of the lower extremities occurred in all patients but in only one in group 1. Onset time and duration of motor block were not significantly different between the three groups. The incidence of hypotension was significantly higher in group 3 (75%) than in groups 1 and 2 (40% in each group). The efficacy of intraoperative analgesia was significantly greater in groups 2 and 3 than in group 1. The incidence of patients requiring analgesics during operation was significantly lower in groups 2 (25%) and 3 (10%) than in group 1 (70%). There was no difference in neonatal condition between the three groups. Spinal anaesthesia with 3.6-4.0 ml of 0.25% bupivacaine in 5% glucose was satisfactory for Caesarean section.

Adding fentanyl 10 micro g to hyperbaric ropivacaine 18 mg for spinal anesthesia for cesarean delivery improves intraoperative anesthesia and increases the analgesia in the early postoperative period.