In view of reports indicating that epidural opioids may improve the analgesic effects of local anesthetics employed for epidural anesthesia for cesarean section, the authors studied 30 healthy women scheduled for elective cesarean section at term. Following placement of a lumbar epidural catheter, all patients received a total dose of 10 ml of 0.5% bupivacaine with all commonly accepted precautions. The patients were then randomly assigned to receive, in a double-blind fashion, 8 ml of 0.5% bupivacaine with 100 μg of fentanyl (Group A) or with saline (Group B). Additional bupivacaine was then given until a T4 sensory level was attained. Note was made of total drug volume injected, time to attain T4block, the intensity of intraoperative pain from skin incision to peritoneal closure, the need for supplemental anesthetic agents, side effects such as nausea, pruritus or ventilatory depression, and neonatal outcome.