Comparison of the Efficacy of Postcesarean Analgesia by Combination of Intraperitoneal Instillation of Local Anaesthetics, Rectus Aponeurosis Infiltration and Infiltration Through the Wound Site Versus Intratechal Morphine: Prospective, Randomised, Double-Blind Study

Background: Cesarean section is a common surgical procedure, and effective postoperative pain management is crucial. This study aims to compare the analgesic efficacy of intraperitoneal local anesthetic (IPLA), rectus aponeurosis infiltra-tion (RAI), and local anesthetic wound infiltration (LWI) with intrathecal morphine (ITM) in elective cesarean sections under spinal anesthesia. Methods: A total of 46 pregnant women undergoing elective cesarean section under spinal anesthesia were randomly assigned to two equal groups: LWI+RAI+IPLA and Morphine. Both groups received spinal anesthesia with 0.5% bupiva-caine and 15 µg fentanyl, while the Morphine group also received 150 µg morphine. The LWI+RAI+IPLA group was administered 30 mL of local anesthetic solution postoperatively. The primary outcome was total morphine consump-tion within 24 hours, and secondary outcomes included pain scores and opioid-related side effects. Results: Except for height (p=0.023), demographic characteristics were similar. No significant differences were observed in pain scores (p > 0.05) or morphine consumption (p=0.075). However, pruritus was significantly higher in the Morp-hine group (p=0.032). Nausea and vomiting occurred in 30.4% of Group M and 8.7% of Group LWI+RAI+IPLA, while pruritus affected 34.8% and 8.7%, respectively. Conclusions: Local anesthetic infiltration and peritoneal instillation provided comparable analgesia to ITM while reducing opioid-related side effects.