Background: Although intraspinal morphine has been shown to be effective in providing analgesia after cesarean delivery, pruritus as a side-effect remains a common cause of dissatisfaction. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory. Methods: We randomized 98 parturients undergoing elective cesarean section using combined spinal-epidural anesthesia into a double-blinded trial to receive tropisetron 5 mg (T group) or ondansetron 8 mg (O group) or placebo (NaCl group) after delivery, when intrathecal morphine 160 mg and fentanyl 15 mg were used for post-operative pain control. The patients additionally received ketoprofen 300 mg per day. Postoperative itching, nausea and vomiting, sedation and need for rescue analgesics were registered every 3 h up to 24 h, and all patients were interviewed on the first post-operative day. Results: Seventy-six percent of the parturients in the placebo group, 87% in the ondansetron, and 79% in the tropisetron group had itching. The incidence of post-operative nausea and

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Two concentrations of etidocaine (1 and 1.5%) and of pH-adjusted bupivacaine (0.5 and 0.75%, pH 6.8), all fortified with hyaluronidase, were compared as local anesthetics in regional ophthalmic surgery for cataract extraction. The series comprised 160 patients assigned randomly to four groups (n = 40). Each patient received one of the four anesthetics in a double blind manner. The technique used was an inferolateral intraconal injection (3 mL) followed by a medial extraconal injection (3 mL). Supplemental injections were given at 10 and 20 min, if needed. At 10 min, globe akinesia was satisfactory in both etidocaine groups and in the 0.75% bupivacaine group (78-80% of patients), but in only 37% of the 0.5% bupivacaine group. In lid akinesia, the 0.75% bupivacaine group gained the highest scores, but there was no significant difference between the groups. Perioperative analgesia was better in both bupivacaine groups, in which only 3 and 5 patients felt pain compared to 7 and 12 in the etidocaine groups (P < 0.05). Of these local anesthetics, pH-adjusted 0.75% bupivacaine is recommended for regional ophthalmic anesthesia.

We evaluated two different doses of intrathecal sufentanil combined with bupivacaine and epinephrine for labor analgesia. Sufentanil 2.5 microg offered an advantage over sufentanil 5 microg because, while providing the same quality and duration of analgesia, it was associated with a reduced incidence of pruritus.

Alkalinized bupivacaine 0.75% (pH 6.8) and a mixture (1:1) of bupivacaine 0.75% and lidocaine 2%, both with hyaluronidase, were compared in regional ophthalmic anesthesia for day-case cataract surgery. Eighty-two patients were randomized into two groups (n = 39 and 43) to receive one of the two solutions in a double-blind manner. Two intraorbital injections were administered initially: an inferolateral intraconal injection (3 mL) and a medial extraconal injection (3.5 mL). The progress of lid and globe akinesia was examined every 2.5 min up to 25 min and postoperatively. The block was supplemented at 10 and 20 min, if needed. Significantly better globe akinesia was achieved with the bupivacaine-lidocaine mixture; the patients who had received alkalinized bupivacaine needed additional injections significantly more often at 10 and 20 min. In lid akinesia, the onset time and recovery were similar in the two groups. One patient in the alkalinized bupivacaine group felt intraoperative pain, and eight patients in the bupivacaine-lidocaine group and seven in the alkalinized bupivacaine group sensed pain postoperatively from corticosteroid and antibiotic injections. Seventy percent of the pH-adjusted bupivacaine group and 8% of the lidocaine-bupivacaine group had diplopia the day after surgery. Of the two local anesthetic mixtures studied, lidocaine (2%) with bupivacaine (0.75%) provided regional ophthalmic anesthesia of better quality.