The Eurasian journal of medicine · 2026
Combined Local Anesthetic Infiltration Versus Intrathecal Morphine for Postcesarean Analgesia: A Pilot Randomized Double-Blind Trial.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
İnce Ramazan, Yılmaz Mehmet Akif, Özkal Yalın Miraç Selcen, Dostbil Ayşenur, Kaşali Kamber, Cimilli Şenocak Gamze Nur, Aksoy Mehmet, Tapanoğlu Karaca Selvihan, Orbak Mehmet Sercan, İnce İlker, Kahramanlar Agah Abdullah
Аннотация
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.
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.