Subarachnoid bupivacaine 0.5% for caesarean section.

A series of 52 patients in whom 0.5% bupivacaine was used to produce spinal analgesia for awake Caesarean section is described. Analgesia tended to be asymmetrical and of limited extent until the patients were turned from the left lateral to the right lateral position immediately after injecting the spinal solution. This movement produced a more symmetrical block with better cephalic spread. Initially 26-gauge spinal needles were passed through a Sise introducer, but this was modified to a needle through needle technique whereby a long-shafted 26-gauge needle was passed through a Tuohy needle which was subsequently used to insert an extradural catheter. The optimal volume of bupivacaine was 2.25-2.75 ml. The mean +/- SEM time to achieve maximal spread of analgesia was 17.5 +/- 0.6 min. The mean- +/- SEM time to the administration of the first postoperative analgesic was 163.5 +/- 7.0 min. The disadvantages of the technique were hypotension and the unpredictable spread of analgesia.