OBJECTIVE: The aim of this prospective cross-sectional study was to determine serum D-dimer and fibrinogen concentrations in pregnant women with hyperemesis gravidarum and compare them with those of healthy pregnant women.

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.

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.