Intrathecal Versus Epidural Morphine for Post-Cesarean Analgesia

This unicentric randomized clinical trial aims to determine whether intrathecal morphine provides superior postoperative analgesia compared with epidural morphine during the first 24 hours following cesarean section. The study population will consist of pregnant women undergoing elective cesarean delivery at Hospital Central do Funchal.

Participants will be randomly assigned to one of two groups. One group will receive postoperative analgesia with intrathecal morphine (80 mcg). The second group will receive epidural morphine, administered as a 2.5 mg bolus at the end of surgery, followed by an additional 2.5 mg bolus 24 hours postoperatively.

The primary outcome will be the assessment of pain during the first 24 postoperative hours. Secondary outcomes will include pain assessment during the first 48 hours, the need for rescue analgesia, levels of sedation, incidence of nausea and vomiting, pruritus, the impact of pain on mobilization and other activities, and overall maternal satisfaction.

Inclusion criteria

• Pregnant women scheduled for elective cesarean section;
• Age > 18 years;
• Willingness to participate in the study, as demonstrated by signed informed consent.

Exclusion criteria

• American Society of Anesthesiologists (ASA) physical status classification > III;
• Chronic kidney disease with a glomerular filtration rate < 60 mL/min;
• Relevant drug allergies (particularly to protocol medications);
• Opioid tolerance;
• Contraindication to neuraxial anesthetic techniques.