Intrathecal Morphine for Cesarean Delivery: A Little Goes a Long Way

Int J Obstet Anesth . 2025 May;62:104363. doi:10.1016/j.ijoa.2025.104363 Cesarean delivery (CD) is among the most frequently performed surgical procedures, accounting for roughly 1 in 5 births worldwide and up to half in some nations. Managing postoperative pain following CD is critical for maternal comfort and also for ensuring mothers can care for themselves and their newborns. Long-term postoperative pain is another critical concern in this population. Although no analgesic approach is universally ideal, intrathecal morphine (ITM) has been refined through decades of research and is now widely adopted, with about 80% of US hospitals using it as a standard method. With ITM, effective analgesia can be achieved with relatively small doses, reducing systemic side effects. The Society for Obstetric Anesthesia and Perinatology (SOAP) recommends avoiding higher doses (over 250 μg), once associated with respiratory depression. Instead, modern practice favors lower doses, where the most common adverse effects are itching, nausea, and vomiting, typically requiring only limited postoperative monitoring.