In contrast to its effect on spinal plain levobupivacaine, we did not find rostral spread of spinal hyperbaric bupivacaine to be less with prophylactic phenylephrine than with ephedrine. We observed an unexpectedly high incidence of fetal acidosis with ephedrine and found evidence that longer spinal-delivery intervals increase the risk of fetal acidosis developing with ephedrine, but not phenylephrine.

No abstract

Patients were similar in baseline characteristics and the risk for PONV, intraoperative management, and intraoperative symptoms of nausea and vomiting. Intraoperative use of fentanyl, antiemetics, or vasopressors did not differ among the three groups. Fetal status at delivery did not differ among groups, nor did postoperative analgesic requirements. The VAS for nausea in those with the TDS patch at the 2 to 6 hours time period (7 mm) and the incidence of vomiting and all emesis in the TDS patch group at the 6 to 24 hours time period (5% and 6%, respectively) were significantly lower in women in the scopolamine group compared with those receiving placebo (15 mm and 17% and 20%, respectively). Retching did not differ among the groups. Overall rates of all emesis were 59.3% in the placebo group, 40% in the TDS group, and 41.8% in the ondansetron group (P = 0.25). Rescue antiemetics were used in 35% to 45% of patients overall in the first 24 hours postoperatively, with a trend toward less use in the TDS group at 2 to 6 hours and 6 to 24 hours (0.05