Effect of spinal versus epidural anaesthesia with 0.5% bupivacaine on lower limb blood flow

Changes in the haemodynamics of the lower extremities, big toe temperature, blood pressure and heart rate were studied in 20 patients undergoing spinal or epidural anaesthesia for transurethral surgery. Calf blood flow was determined by strain gauge plethysmography (SGP) and Doppler ultrasound. Bupivacaine 0.5% was injected at the L3-L4 interspace, the dose being 3-4 ml (mean 3.6) in the spinal and 17-20 ml (mean 18.6) in the epidural group. The number of sensory blocked segments 30 min after anaesthesia was 12.7 +/- 0.7 (mean +/- s.e.mean) and 14.4 +/- 0.7, respectively. Only minor decreases in blood pressure were noted following the blocks. Heart rate remained virtually unchanged. The increase in skin temperature was more pronounced (P less than 0.01) following epidural (mean 8 degrees C) than spinal anaesthesia (mean 4 degrees C). In addition, the arterial blood flow was significantly higher (P less than 0.05) following epidural than spinal block (means 3.5 and 2.2 ml/100 ml/min, respectively). The venous capacity and maximum venous outflow remained practically unchanged in both groups. Obviously, epidural anaesthesia with bupivacaine causes a more intensive sympathetic block than does spinal anaesthesia. As probably no venous pooling occurred, when examined by SGP and Doppler ultrasound, neither of the blocks is likely to contribute to the initiation of deep vein thrombosis.     

Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for Caesarean section

BACKGROUND: This prospective double-blind trial evaluated the effect of sufentanil addition to epidural ropivacaine for elective Caesarean section. METHODS: Sixty healthy parturients were randomly assigned to receive an initial dose of 90 mg of plain ropivacaine, or 90 mg of ropivacaine plus 10 or 20 microg of sufentanil (n = 20 each). Before surgery, if necessary, additional epidural ropivacaine was injected. Primary outcome parameter was time to achieve sensory block at T4. RESULTS: Time to reach the sensory block was remarkably reduced (P < 0.001 each) by addition of 10 or 20 microg of sufentanil (21 +/- 8 min, 15 +/- 5 min, 11 +/- 4 min in the plain ropivacaine, the 10- and 20-microg sufentanil groups, respectively) whereas the visual analogue scale (VAS) scores at delivery were significantly reduced (P = 0.028) only by 20 microg of sufentanil (32 +/- 35 mm in the plain ropivacaine vs. 9 +/- 19 mm in the 20-microg sufentanil groups). The total dose of ropivacaine was significantly lower (P = 0.005) in patients receiving 20 microg of sufentanil (100.5 +/- 15.0 mg) compared with those treated with plain ropivacaine (118.5 +/- 17.3 mg). The incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus) and neonatal outcome [APGAR score, neurologic and adaptive capacity (NAC) score, umbilical cord blood-gas values] did not differ between the groups. CONCLUSION: Our results suggest that addition of 20 microg of sufentanil improved the epidural anaesthesia with ropivacaine 0.75% for Caesarean section.     

The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers

Background: Continuous epidural infusions of local anaesthetics have become increasingly popular in postoperative pain treatment, especially as they permit early mobilisation. Ropivacaine is a promising new agent which induces more pronounced sensory than motor blockade. This study was focused on the influence of continuous epidural infusion of ropivacaine on impulse conduction in large nerves (by measurement of F and H latencies), and on the subjects' ability to maintain postural control during mobilisation. Methods: Healthy male volunteers received 0.1%, 0.2% or 0.3% ropivacaine, and bupivacaine 0.25% was used as reference. A bolus epidural injection of 10 ml of the drug, at L2/3 level, was followed by continuous infusion at 10 ml/h for 21 h. Motor blockade was assessed by mechanical measurements of force during big toe flexion and by recording of F latency. Sensory blockade was monitored by pin-prick and Thermotest methods, and by H latency recording. The subjects' ability to perform a postural test was evaluated by posturography. Results: The F and H latencies became prolonged/abolished dose-dependently. With ropivacaine, F latency recovered significantly later than motor function (P = 0.0002), and H latency recovered later than normal pin-prick perception (P = 0.0006). However, the duration of partial blockade of thermopercep-tion was comparable to that of H latency prolongation. Posturographically, the subjects receiving 0.1% ropivacaine differed significantly from all others (P<0.001) in that they were able to maintain postural control during the infusion. The recovery period after termination of infusion was significantly shorter with ropivacaine than with bupivacaine for all measured variables. Conclusion: Recovery of postural control with 0.2% and 0.3% ropivacaine is significantly faster than with bupivacaine 0.25%. H latency recording allows detection of epidural blockade intensity that does not prevent subjects from performing postural tests.     

The effect on uteroplacental blood flow of epidural anaesthesia containing adrenaline for caesarean section

The effect on uteroplacental blood flow of an epidural anaesthesia containing adrenaline for caesarean section was investigated in ten healthy women using dynamic placental scintigraphy with indium-113m and a computer-linked gamma camera. The epidural anaesthesia was performed with 18-22 ml bupivacaine 5 mg/ml with adrenaline 2.5 micrograms/ml followed by an i.v. balanced electrolyte infusion of 10 ml/kg b.w. A significant median decrease in the total maternal placental blood flow of 34% was found (P less than 0.01). There was also a significant decrease in maternal mean blood pressure of 3 mmHg (0.4 kPa) (P less than 0.05) and a significant negative correlation between the change in maternal blood pressure and the change in uteroplacental blood flow (r = -0.69, P less than 0.05).     

芬太尼对罗哌卡因低位硬膜外麻醉效果的影响

目的探讨芬太尼对罗哌卡因行低位矿膜外麻醉时的麻醉效果及其量效关系的影响。方法60例ASAI-Ⅱ级择期腰椎间盘手术成年病人，随机分为A、B、C三组，每组20例，均于T12／L1椎间隙行硬膜外腔穿刺，向下置管3cm。硬膜外局麻药配方分别为：A组0．5％罗哌卡因、B组0．5％罗哌卡因＋芬太尼2mg／L、C组0．5％罗哌卡因＋芬太尼4mg／L。观察记录麻醉效果，持续时间，运动阻滞程度及副作用等。应用Probit半数效量回归法分别计算三组ED50值和ED95值。结果三组配方60例病人在腰椎手术中行硬膜外麻醉有58例获得满意效果。罗哌卡因在C组ED50值和ED95值均明显小于A组（P〈0．05）。C组麻醉持续时间较A、B组长，Bromage评级较A、B组低（P〈0．05），三组间不良反应发生例数无统计学意义（P〉0．05）。结论低位硬膜外麻醉时芬太尼能明显增强罗哌卡因麻醉效果，延长麻醉作用时间，并减轻下肢运动阻滞程度，其中C组效果最佳。     

Extending low-dose epidural analgesia for emergency Caesarean section using ropivacaine 0.75%

We compared ropivacaine 0.75% and bupivacaine 0.5% for extending low-dose epidural analgesia for emergency Caesarean section, using a prospective double-blind randomised controlled trial design. The trial was halted after 45 patients were studied (23 ropivacaine; 22 bupivacaine) because bupivacaine was replaced by levobupivacaine in our unit. Time to reach T4 for loss of cold sensation was similar in both groups, although analgesic supplementation was required less often in the ropivacaine group than in the bupivacaine group (2/23 vs. 9/21; p = 0.01).     

Pharmacokinetic profiles of epidural bupivacaine and ropivacaine following single-shot and continuous epidural use in young infants

Aims: The primary aim of this study was to describe the pharmacokinetics of total and unbound bupivacaine and ropivacaine following epidural bolus and infusion in neonates and young infants. Secondary aims were to investigate the influence of alpha‐1‐acid glycoprotein (AAG) on the concentration–time profiles and to determine the efficacy and adverse event profile of the epidural regimen. Methods/Materials: Thirty‐one infants aged 40–63 weeks of postmenstrual age (PMA) undergoing hernia repair or abdominal surgery received an epidural injection of 1.5 mg·kg^?1 bupivacaine (0.25%) or ropivacaine (0.2%) followed 2 h later by an infusion of 0.2 mg·kg^?1·h^?1 in those undergoing abdominal surgery. Total and unbound concentrations of bupivacaine and ropivacaine were analyzed using nonmem . Hourly pain scores and adverse effects were recorded. Results: Bupivacaine data were available from 11 infants (five had infusions) and ropivacaine from 13 infants (four had infusions). Alpha‐1‐acid glycoprotein and total bupivacaine and ropivacaine concentrations accumulated during infusions, but unbound concentrations did not. Maximum unbound concentrations for bupivacaine and ropivacaine were 0.12 mg·l^?1 (bupivacaine) and 0.13 mg·l^?1 (ropivacaine). Typical clearance/bioavailability estimates of total (unbound) bupivacaine were 0.215 (4.65) l·h^?1·kg^?1 and of total (unbound) ropivacaine were 0.288 (3.31) l·h^?1·kg^?1. Pain scores requiring pain team referral occurred once with bupivacaine and four times with ropivacaine. No toxicity was observed. Conclusions: Epidural infusions of 0.2 mg^?1·kg^?1·h^?1 bupivacaine or ropivacaine appeared to be well tolerated and efficacious in this population. No accumulation of unbound drug concentrations occurred.     

0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine

BACKGROUND AND OBJECTIVES: Although ropivacaine has been extensively studied for epidural anesthesia, very few reports exist on brachial plexus block. We therefore decided to investigate the clinical features of axillary brachial plexus anesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare the results with those obtained with 0.5% bupivacaine. METHODS: Three groups of patients were randomized and prospectively studied. They received, in a double-blind fashion, 32 mL of the local anesthetic solution into the midaxilla, by a nerve-stimulator technique. Onset time in each of the stimulated nerves was recorded both for the sensory and motor block. Peak time (ready to surgery), rate of supplemental blocks, need for intraoperative opioids, duration of sensory and motor block, postoperative analgesic requirements, and patient satisfaction were also recorded. RESULTS: The rate of complete sensory and motor block observed with both ropivacaine groups was higher at 10, 15, and 20 minutes postinjection (P < .001). The mean peak time was shorter with ropivacaine than with bupivacaine (R50 = 16.37 minutes, R75 = 14.7 minutes, B = 22.3 minutes, P < .05). The quality of the anesthesia was higher with ropivacaine, as measured by the intraoperative needs for opioids and the overall patient's satisfaction (P < .05). No significant differences were noted with all the other studied parameters. CONCLUSION: Ropivacaine showed advantages over bupivacaine for axillary brachial plexus block. Because no statistical differences were found between the two ropivacaine groups, we therefore conclude that 0.75% does not add benefit and that 0.5% ropivacaine should be used to perform axillary brachial plexus blocks.     

Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section

The uteroplacental blood flow was measured before and during epidural anaesthesia for caesarean section in 11 women. The blood flow was measured with dynamic placental scintigraphy. After an i.v. injection of indium-113m chloride, the gamma radiation over the placenta was recorded with a computer-linked scintillation camera. The uteroplacental blood flow could be calculated from the isotope accumulation curve. The anaesthesia was performed with bupivacaine plain 0.5%, 18-22 ml and a preload of a balanced electrolyte solution 10 ml/kg b.w. was given. The placental blood flow decreased in eight patients and increased in three with a median change of -21%, not being statistically significant. No correlation between maternal blood pressure and placental blood flow was found.     

A double-blind randomised comparison of ropivacaine 0.5%, bupivacaine 0.375% - lidocaine 1% and ropivacaine 0.5% - lidocaine 1% mixtures for cataract surgery

This study evaluated the efficacy and side-effects of plain ropivacaine compared with ropivacaine-lidocaine and bupivacaine-lidocaine mixtures for peribulbar blocks in cataract surgery. Ninety patients were randomly allocated to three groups and received peribulbar blockade using one of the three solutions. Speed of onset and quality of blockade were assessed using akinesia, surgical satisfaction and patient satisfaction. Complications and cardiovascular side-effects were noted. There was a slower onset of akinesia using ropivacaine alone, although at 10 min after injection all groups were equal in this respect. There was no difference in surgical or patient satisfaction between the groups. There were no differences in pain on injection, preblock and postblock blood pressure, heart rate or oxygen saturation. The optimal time to surgical incision after peribulbar blockade is not less than 15 min and plain ropivacaine fulfils this criterion.     

Comparative evaluation of four different infusion rates of ropivacaine (2 mg/mL) for epidural labor analgesia

Background and Objectives. Previous studies have reported comparable efficacy for ropivacaine and bupivacaine when used for labor analgesia at concentrations of 2.5 mg/mL. In this multicenter study, we assessed ropivacaine at the commercially available concentration of 2 mg/mL (0.2%) for labor pain management. Methods. After Institutional Review Board approval and informed consent, 128 women at term were randomly assigned to receive ropivacaine at one of the four infusion rates via a lumbar epidural catheter. Analgesia was initiated with a 5-mL test dose, followed by injections of 5–15 mL of 2 mg/mL ropivacaine. The continuous infusion was then started at 4, 6, 8, or 10 mL/hour. Rescue analgesia was provided with 5-mL “top-up” injections as necessary to provide maternal comfort. Pain relief was assessed by using a visual analog pain scale (VAPS) and motor block was assessed by using a modified Bromage scale. Results. All infusion regimens effectively decreased VAPS, and most patients in all groups had minimal or no motor block at the end of the first stage of labor. Mean total number of the top-up injections required per patient were 3, 2, 1.5, and 1.4, respectively, in the 4, 6, 8, and 10-mL/hour groups (P < .05, 4 mL/hour vs. all other groups). Despite receiving more total bolus dosages, the 4-mL/hour group had less motor block in the lower extremities (P < .05). Apgar scores and neurological adaptive capacity scores were similar for all groups. Conclusions. The 2 mg/mL of ropivacaine produces satisfactory labor analgesia at epidural infusion rates of 4, 6, 8, and 10 mL/hour, provided supplemental bolus dosages are available. Clinically, a rate of 6 mL/hour may be the lowest effective rate that provides the best combination of pain relief, motor block, and rebolusing, although rates of 8 and 10 mL/hour produced similar results.     

舒芬太尼静脉或硬膜外给药对子宫切除术病人罗哌卡因硬膜外麻醉效果的影响

目的评价舒芬太尼静脉或硬膜外给药对子宫切除术病人罗哌卡因硬膜外麻醉效果的影响。方法择期行子宫切除术病人60例，年龄30～55岁，体重40～70k，随机分为3组（n=20）：硬膜外罗哌卡因组（R组）、硬膜外罗哌卡因混合舒芬太尼组（RS组）、硬膜外罗哌卡因复合静脉舒芬太尼（IVS组）。行L2.3间隙行硬膜外穿刺，头向置管3．5cm，给予2％利多卡因3ml。5min后R组硬膜外注入0．75％罗哌卡因13ml混合生理盐水2ml；RS组硬膜外注入0．75％罗哌卡因13ml混合20μg（2ml）舒芬太尼，R组及RS组均同时静脉注射生理盐水2ml；IVS组硬膜外注入0．75％罗哌卡因13ml混合生理盐水2ml，同时静脉注射舒芬太尼20μg（2m1）。观察感觉阻滞起效时间、感觉阻滞达到的最高平面和时间、感觉阻滞持续时间、运动阻滞起效时间、运动阻滞持续时间、腹部肌肉松弛程度、麻醉效果、清醒程度及不良反应。结果三组间下肢运动阻滞起效时间、持续时间和Bromage评分差异无统计学意义。舒芬太尼静脉和硬膜外给药均可缩短感觉阻滞起效时间，延长感觉阻滞持续时间但在感觉阻滞达到的最高平面腹部肌肉松弛程度和麻醉效果方面舒芬太尼硬膜外给药的效果优于静脉给药，且病人均处于清醒状态。结论与静脉注射比较，硬膜外给予小剂量舒芬太尼可增强子宫切除术病人罗哌卡因硬膜外麻醉的效果，且不增加镇静作用。     

Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section

BACKGROUND: So far only ropivacaine concentrations of 0.5 and 0.75% have been used for Caesarean section. This prospective double-blind trial evaluated the anaesthetic quality of ropivacaine 1% with and without sufentanil addition. METHODS: Three groups of patients (n=20 each) scheduled for an elective Caesarean section were studied. The patients received initially 120 mg ropivacaine, or 120 mg ropivacaine plus 10 microg or 20 microg sufentanil. Additional epidural ropivacaine was injected if necessary. Primary outcome parameter was time to achieve sensory block at T4. Moreover, pain intensity at delivery (visual analogue scale, VAS), incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus), and neonatal outcome (Apgar score, neurologic and adaptive capacity score, umbilical cord blood-gas values) were recorded. RESULTS: The onset time for the sensory block was not significantly different among the groups. Also, VAS scores at delivery did not differ significantly between the plain ropivacaine 1% group (18 +/- 29 mm), the 10-microg sufentanil group (1 +/- 5 mm), and the 20-microg sufentanil group (6 +/- 18 mm). The total dose of ropivacaine was significantly higher in the plain ropivacaine 1% group (145 +/- 19 mg) compared to the patients receiving additional 10 microg sufentanil (130 +/- 15 mg, P = 0.02) or 20 microg sufentanil (129 +/- 16 mg, P = 0.01). The incidence of maternal side-effects and neonatal outcome were similar in all groups. CONCLUSION: Ropivacaine 1% alone provided sufficient analgesia. Sufentanil addition did not significantly improve the quality of epidural anaesthesia with ropivacaine 1.0% for Caesarean section.     

预先输注不同脂肪乳对罗哌卡因硬膜外麻醉后血浆浓度与药效动力学的影响

目的 研究预先输注不同脂肪乳(lipid emulsion,LE)对下肢手术罗哌卡因硬膜外麻醉后血浆浓度与药效动力学的影响.方法 择期下肢手术的成年患者29例,美国麻醉医师协会(ASA) Ⅰ～Ⅱ级.采用完全随机法分为3组:生理盐水组(NS组,n=11)、中/长链LE组(MLE组,n=8)、长链LE组(LLE组,n=10).分别以2ml· kg-1· h-1速度泵注0.9％氯化钠注射液、20％ MLE、20％LLE,持续30 min.硬膜外腔注射1％罗哌卡因2 mg/kg后1(N1)、5(N2)、10(N3)、15(N4)、30(N5)、45(N6)、60(N7)、90(N8)、120 min(N9)时动脉采血检测血浆罗哌卡因浓度.记录术中血流动力学指标、麻醉质量评分、感觉及运动阻滞情况等.结果 术中血流动力学参数、麻醉质量评分、感觉与运动神经阻滞效果组间比较,差异无统计学意义.组间比较血浆罗哌卡因浓度差异无统计学意义.结论 预先输注不同LE对下肢手术罗哌卡因硬膜外麻醉后的血流动力学影响甚微,亦不影响感觉、运动神经阻滞效果及血浆罗哌卡因浓度.     

Glinical study about low epidural block efficacy of ropivacaine and bupivacaine at the equivalent concentrations

Objective：The purpose of this prospective, randomized, double-blind study was to compare the low epidural block efficacy of ropivacaine and bupivacaine at the equivalent concentrations. Methods Eighty patients （44 male and 36 female patients） undergoing selective lower abdominal or lower extremity surgery were allocated randomly to four groups with 20 in each, receiving 0.5% bupivacaine （group B0.5）, 0.5% ropivacaine （group R0.5）, 0.75% bupivacaine （group B0.75） and 0.75% ropivacaine （group R0.75）, respectively. Prior to surgery, with double blind method, 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine as local anesthetic solutions were injected respectively via epidural catheters at interspace of L2-3 or L3-4. Patients received the experimental drug 4 ml as a catheter test dose in order to avoid the catheter being improperly placed into the subarechnoid space. Ropivacaine or bupivacaine 3-5ml was administered at five minutes intervals until anesthetic effect had met surgery demand. （The segmental level of sensory block by pinpricking had extended above the top of surgery incision.） During the procedure, no additional study drug was injected into the epidurel space while the patients were being recorded, including onset time, the efficacy of sensory moter block, duration, cardiovascular effects, the quality of analgesia and neuromuscular block, adverse reactions and complications. All subjects were continuously monitored non-invasion blood pressure, heart rate（HR）, oxygen saturation measured by pulse oximetry（SpO2） and electrocardiogram（EEG） throughout surgery. Results：The anesthesia of all subjects was appropriate for surgery. With 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine in the equivalent dosages, onset time, duration of sensory block, and the efficacy of motor block（mostly Bromage 3） was not significantly different between the groups（P 〉0.05）. Increasing the concentration of ropivacaine could leaded to a longer duration of motor block, especially in group R0.75（P〈0.01）. The cephalad dermatomal level of analgesia accessed by pinpricking was mostly T8-T10 for all groups. Because the difference between the peak or the valley ,and the baseline ,of SpO2, HR, BP, and PP was not statistically significant（P 〉 0.05）, the study drug didn＇t show obvious effects on haemodynamics. The minority of the patients, distributed among the four groups, complained of udnary retention after the operation.
Conclusions：The data from the patients undergoing lower abdominal or lower extremity surgery, who received lower anesthesia with 0.5%, 0.75% ropivacaine or 0.5%, 0.75% bupivacaine in the equivalent volumes respectively revealed that anesthetic efficiency could meet surgery demand. Onset time of the tow drugs, ropivacaine and bupivacaine, was similar at the equivalent concentrations, there was no difference in duration and efficacy of sensory and motor block, and in the cephalad spread degree of epidurel anesthetics, between ropivacaine and bupivacaine at the equal dosages. The higher concentrations of ropivacaine appeared to be obviously associated with a more prolonged duration of sensory block.     

Blockade of the abdominal muscles measured by EMG during lumbar epidural analgesia with ropivacaine – a double-blind study

A single shot of 20 ml of 1%, 0.75% or 0.5% ropivacaine was administered epidurdlly (at L2/3 level) to 30 volunteers, in a double-blind manner. The blockade of the rectus abdominis muscle was measured quantitatively by registration of the average rectified electromyographic signal (AREMG) at the T7, T9 and T11 motor segmental levels and with a qualitative test for blockade of the rectus abdominis muscle (the so-called RAM test). The maximal cranial spread ofanalgesia, evaluated by the pin-prick method, was not significantly different for the three concentrations (T8-T10 dermatome; median value). The intensity of motor blockade, measured by the AREMG method, increased progressively from the T7 segment and caudally with all three concentrations. The blockade was partial (Le. 85–25% of baseline AREMG activity was present at its maximum) in all subjects. When the effect of the three concentrations of ropivacaine was compared at the same segmental level, the intensity and duration of maximal motor blockade seemed to be dose-dependent, but the difference was not statistically significant. The total duration of motor blockade was shorter with the 0.5% solution than with the higher concentrations. The AREMG method gave a more exact and graded picture of blockade of the rectus abdominis muscle than the RAM test. The duration of sensory blockade did not outlast motor blockade at any level. In half of our subjects the maximal spread of sensory blockade was either equal to or higher than the spread of partial motor block. In the other half, this relationship was reversed - the maximal cranial level of partial motor block was 1–4 segments higher than the maximal level of analgesia.     

Comparison of epidural anaesthesia with ropivacaine 0.5% and bupivacaine 0.5% for Caesarean section

PURPOSE: To compare ropivacaine 0.5% with bupivacaine 0.5% for epidural anaesthesia for Caesarean section. METHODS: Healthy pregnant women, scheduled for elective Caesarean section were enrolled into this randomized, double-blind, parallel-group study. Epidural block was obtained with 20-30 ml of ropivacaine (group R) or bupivacaine (group B) and surgery started when anaesthesia was reached T6. Maternal heart rate and blood pressure and fetal heart rate were assessed before the test dose and at five minute intervals until the end of surgery. At the same intervals, sensory and motor block characteristics were determined. Apgar scores and Neurologic and Adaptive Capacity Scores (NACS) were determined after delivery. Adverse events were recorded. RESULTS: Sixty-five patients were enrolled and data from 61 were available for analysis; 30 ropivacaine and 31 bupivacaine. Time from the end of the last injection to the start of surgery was 46 +/- 13 min (mean +/- SD) in gp R and 53 +/- 25 min in gp B (P:NS). The median duration of analgesia varied between 1.7 and 4.2 hr in gp R and between 1.8 and 4.4 hr in gp B (P:NS). In patients who developed Bromage 4 block, it persisted longer in those in gp B (2.5 hr) than in gp R (0.9 hr) (P < 0.05). The quality of analgesia was satisfactory in 27/29 patients (93%) in gp R and 27/31 patients (87%) in gp B (P:NS), although supplemental i.v. opioid was required in ten and seven patients, respectively. The most common adverse events in the mother were hypotension (63% gp R and 61% in gp B) (NS) and nausea (30% and 58%, in group R and B, respectively) (P = 0.05). Apgar scores were 7 after five minutes in all neonates. CONCLUSION: Ropivacaine 0.5% and bupivacaine 0.5% provided effective epidural anaesthesia for Caesarean section although supplementation with i.v. opioid was commonly required.