Subarachnoid block with hyperbaric bupivacaine and morphine may shorten PACU stay after cesarean delivery

Spinal anesthesia for cesarean delivery is a widely used modality. Both hyperbaric and isobaric bupivacaine are in clinical use, with or without the addition of opioids, but the baricity of intrathecal bupivacaine has not been correlated with recovery time after cesarean delivery. One hundred parturients scheduled for elective cesarean delivery were randomly divided into four groups: hyperbaric bupivacaine (10 mg), hyperbaric bupivacaine (10 mg) with morphine (100 mcg), isobaric bupivacaine (10 mg), and isobaric bupivacaine (10 mg) with morphine (100 mcg). All groups received additional intrathecal fentanyl 15 mcg. Recovery from motor block, postoperative nausea and vomiting, and postoperative pain, as well as analgesic requirements were documented. The four groups did not differ in the rate of intraoperative and postoperative adverse effects. Parturients receiving hyperbaric bupivacaine recovered from motor block earlier and were less likely to require analgesic supplements, thus meeting PACU discharge criteria sooner. The addition of intrathecal morphine did not significantly delay postoperative recovery or discharge from the PACU and further reduced analgesic requirements. Spinal anesthesia with hyperbaric bupivacaine 10 mg with or without morphine 100 mcg provided faster, less painful recovery compared with either isobaric bupivacaine with or without morphine when added to fentanyl 15 mcg, enabling faster discharge from the PACU.