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We have compared the efficacy of 0.25% S(-)-bupivacaine with 0.25% RS-bupivacaine in providing epidural analgesia for labour in a randomized, multicentre, double-blind study. Analgesia was initiated with 10 ml of the study solution and maintained with 10-ml top-ups. We studied 137 women and treatments were found to be equivalent for onset, duration and quality of block. Median onset of pain relief was 12 min for both drugs and median duration was 49 (range 3-129) min and 51 (7-157) min for S(-)-bupivacaine and RS bupivacaine, respectively. The estimated treatment difference for duration of pain relief was -4 (90% CI -13, 6) min. Thirty patients failed to achieve pain relief after the first injection (20 patients after S(-)-bupivacaine and 10 after RS-bupivacaine; P = 0.039). However, median duration of pain relief from the first top-up was 82 (range 3-164) min for S(-)-bupivacaine and 76 (22-221) min for RS-bupivacaine. There were no significant differences in the quality of analgesia, as assessed by the investigators. There were no significant differences in the extent of sensory block, percentage of patients with motor block or incidence of adverse events.

Twenty patients undergoing transurethral prostatectomy under spinal anaesthesia were allocated randomly in one of two groups. After operation dermatomal levels to cold were measured every 30 min until they had receded to T10. Patients in group 1 were then given diamorphine 5 mg in 0.9% saline 5 ml i.v. and in group 2 0.9% saline 5 ml i.v. Block level to cold and degree of motor block were assessed at 15-min intervals for 1 h after injection. Block regression continued in the control group while there was no decrease in the diamorphine group for 30 min (P < 0.01) after which it then receded at a similar rate as the control group. There was no significant difference in motor block between the two groups.