Enhanced recovery after caesarean section (ERAC) protocols have improved patient outcomes. Which single intervention has the most consistent evidence for reducing opioid consumption after cesarean section without compromising analgesia quality?

• A IV patient-controlled analgesia (PCA) with morphine post-operatively
• B Wound infiltration with bupivacaine alone
• C Intrathecal morphine 100–150 mcg added to spinal anaesthetic ✓
• D Scheduled IV ketorolac as the sole analgesic

Explanation

Intrathecal morphine (100–150 mcg) added to the spinal anaesthetic for cesarean section is the single most evidence-based intervention for providing extended postoperative analgesia (12–24 hours) and reducing systemic opioid consumption by 50–70%. It is the cornerstone of ERAC multimodal analgesia. While IV PCA and scheduled NSAIDs are components of multimodal analgesia, intrathecal morphine provides the greatest opioid-sparing effect. Side effects (pruritus, nausea, delayed respiratory depression) are managed with monitoring.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.