ArticleThe Eurasian journal of medicine2026
Combined Local Anesthetic Infiltration Versus Intrathecal Morphine for Postcesarean Analgesia: A Pilot Randomized Double-Blind Trial.
Article in The Eurasian journal of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis 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.
methodsForty-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.
resultsRescue 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.
conclusionTwenty-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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