In this study we compared the analgesic effects, safety and duration of intraoperative intrathecal ropivacaine versus neostigmine with ropivacaine. Furthermore we evaluated the effectiveness of analgesia not only in pain control, but also in blocking the stress response to surgery, which includes hemodynamic, endocrinal and metabolic effects.The study showed that adding neostigmine (50 μg) to ropivacaine (15 mg) enhance the efficacy of ropivacaine induced spinal anaesthesia through prolongating the duration of sensory block. But it increased the requirement for antiemetic treatment and produce vomiting that may be resistant to therapy. Intrathecal neostigmine suppressed the increase in plasma cortisol level during early periods of the surgery, and improved the postoperative pain status of patients.