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Combined Local Anesthetic Infiltration Versus Intrathecal Morphine for Postcesarean Analgesia: A Pilot Randomized
Ramazan İnce1, Mehmet Akif Yılmaz2, Miraç Selcen Özkal Yalın2
1Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Health Sciences University, Erzurum, Türkiye.
Background:
This exploratory pilot randomized double-blind trial compared postoperative analgesic outcomes of combined local wound infiltration, rectus aponeurosis infiltration, and intraperitoneal local anesthetic instillation (LWI+RAI+IPLA) with intrathecal morphine (ITM) after cesarean delivery.
Methods:
Forty-six women undergoing elective cesarean delivery under spinal anesthesia were randomized to receive either ITM (150 μg) or LWI+RAI+IPLA using a bupivacaine-lidocaine-epinephrine mixture. Both groups received standardized spinal bupivacaine-fentanyl and postoperative multimodal analgesia. The primary endpoint was 24-hour rescue morphine consumption. Secondary endpoints included pain scores, time to first rescue opioid request, and opioid-related adverse effects.
Results:
Rescue morphine consumption was numerically higher with LWI+RAI+IPLA than with ITM, but the difference was not significant (1.3 ± 2.22 vs 0.34 ± 0.98 mg; P = .075). Pain scores at rest and during movement did not differ significantly at any time point. Time to first rescue opioid request was longer with ITM (23.04 hours [95% CI, 21.30-24.79] vs 18.70 hours [95% CI, 15.36-22.04]; log-rank P = .032). Nausea/ vomiting was more frequent with ITM but was not significant (30.4% vs 8.7%; P = .135), whereas pruritus was significantly more frequent with ITM (34.8% vs 8.7%; P = .032). No respiratory depression occurred.
Conclusion:
Twenty-four-hour opioid consumption and pain scores did not differ significantly between groups. Intrathecal morphine prolonged the time to first rescue opioid request, whereas LWI+RAI+IPLA caused less pruritus. Because this pilot study was not powered for equivalence or noninferiority and showed a floor effect in opioid consumption, larger adequately powered trials are needed. Cite this article as: İnce R, Yılmaz MA, Özkal Yalın MS, et al. Combined local anesthetic infiltration versus intrathecal morphine for postcesarean analgesia: a pilot randomized double-blind trial. Eurasian J Med. 2026, 58(4), 1445, doi: 10.5152/ eurasianjmed.2026.261445.
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