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Despite the increasing popularity of epidural analgesia in obstetrics, most Caesarean sections in the United Kingdom are still performed under general anaesthesia.' Where epidural analgesia has been established to provide pain relief in labour, extension of the block for Caesarean section is usually possible and can avoid the necessity for general anaesthesia. This paper reports the outcome of applying this policy in 722 consecutive cases. MethodThe implications of epidural analgesia for Caesarean section were explained to the patients and the block extended by a dose of 16 ml bupivacaine (Marcain) 0.5 %, without adrenaline, 8 ml with the patient in the left lateral position, and, after an interval of 5 min, the remainder in the right lateral position. When necessary, additional bupivacaine was given to ensure that analgesia extended to all nerve roots below the sixth thoracic dermatome. All patients received a fluid load (approximately I litre) of either dextrose 5 % in water or Hartmann's solution during extension of the block. The arterial blood pressure was recorded at intervals of I-min using an 'Arteriosonde' automatic blood pressure recorder. Hypotension, defined as a fall in systolic blood pressure below 90 mmHg or a reduction of more than 30% of the initial systolic value, was corrected by increasing the rate of intravenous infusion and, when considered necessary, by the intravenous administration of 10-15 mg ephedrine hydrochloride. A Crawford wedge was placed under the patient's right side and oxygen administered byaHudsonmaskwithaflowrateof 4litreslmin. AII patients remained unsedated until after delivery apart from any analgesic which may have been administered during labour before establishment of the epidural. Syntocinon 2 units was injected intravenously, followed by an infusion of 10 units syntocinon in 500 ml 5 : ; dextrose in water. When delivery was complete and the mother had seen her baby, most patients received intravenous papaveretum and hyoscine to a maximum dose of 20 and 0.4 mg respectively. The mothers were interviewed 2 to 3 days after operation and were encouraged to give a frank opinion of their experience. ResultsIn 168 patients (23.2%) no attempt was made to use the epidural for surgery and a general anaesthetic was administered for reasons summarised in Table 1. In the remaining 554 patients (76.8 %) it appcared that successful extension of the block had been achieved. In 533 of these patients (96.27;) the operation was completed under epidural analgesia alone; the