Temperature Dysregulation Following Intrathecal Morphine for Cesarean Delivery Patients-A Scoping Review

Intrathecal morphine is widely used for postoperative analgesia following cesarean delivery. However, intrathecal morphine's potential association with hypothermia remains uncertain, although hypothermia may adversely affect maternal recovery and comfort. This scoping review aims to map the available evidence regarding temperature dysregulation associated with intrathecal morphine in patients undergoing cesarean delivery.

We conducted a scoping review according to the PRISMA-ScR guideline. A systematic literature search was performed in Medline, Embase, The Cochrane Library, and Cinahl. Studies reporting temperature outcomes in patients receiving intrathecal morphine during cesarean delivery were eligible. The primary outcome was the incidence of hypothermia or hyperthermia. Secondary outcomes included changes in core temperature, dose-response relation, duration, severity of temperature dysregulation, and impact on recovery.

A total of 35 studies published between 1991 and 2025 were included. Four studies evaluated intrathecal morphine as intervention, whereas it was administered as standard care provided for all trial patients in the remaining studies. A total of 20 studies reported the incidence of hypothermia, corresponding to a pooled incidence of 21% among 773 patients. No studies reported an increase in temperature. A total of 12 case reports described severe hypothermia attributed to intrathecal morphine. However, our explorative analysis did not show an association between intrathecal morphine and hypothermia, and no dose response was identified. Clinical outcomes were infrequently reported, though several hypothermic patients were described as asymptomatic, suggesting that hypothermia may be clinically under-recognized.

Current evidence does not demonstrate a consistent association between intrathecal morphine and hypothermia following cesarean delivery. However, interpretation is limited by substantial heterogeneity across studies. This scoping review highlights an important evidence gap in the literature and supports the need for well-designed studies to clarify whether intrathecal morphine contributes to clinically relevant hypothermia.

This review presents an overview of the evidence concerning intrathecal morphine treatment and post-caesarean temperature dysregulation. The evidence is incomplete, and this scoping review highlights areas where higher quality evidence is needed.