Moisa Ramona Celia, Negrut Nicoleta, Botea Mihai Octavian, Bodog Teodora Maria, Moisa Cezar Cristian Mihai, Thomas Treesa Clare, John Harrie Toms
Clinic of Anaesthesia and Intensive Care, Pelican Clinic, Medicover Hospital, Oradea, ROU.
Doctoral School of Biomedical Sciences/Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU.
Cureus. 2025 Apr 28;17(4):e83109. doi: 10.7759/cureus.83109. eCollection 2025 Apr.
Intrathecal opioids (ITOs), such as morphine, fentanyl, and sufentanil, are widely used as adjuvants in spinal anesthesia for cesarean sections to enhance postoperative analgesia and reduce systemic opioid exposure. Optimizing their selection and dosing is critical to balancing effective analgesia with maternal and fetal safety. This article aims to critically analyze the use of intrathecal opioids in spinal anesthesia for cesarean sections, focusing on their mechanisms of action, clinical benefits, associated risks, and role within Enhanced Recovery After Surgery (ERAS) protocols. A comprehensive narrative review was conducted using PubMed, Scopus, and Google Scholar to identify relevant literature published between January 2010 and March 30, 2025. Morphine provides prolonged postoperative analgesia but is associated with higher rates of pruritus and delayed respiratory depression. Fentanyl and sufentanil offer faster onset but shorter analgesic duration. Combining intrathecal opioids with local anesthetics improves hemodynamic stability and reduces overall opioid requirements. While adverse effects are common, they are dose-dependent and manageable with appropriate monitoring. The tailored selection of intrathecal opioids, guided by pharmacological profiles and patient-specific factors, enhances analgesia and patient-specific safety in cesarean delivery. Refining dosing strategies and integrating multimodal analgesia protocols are essential to minimize adverse effects and optimize maternal and neonatal outcomes.
鞘内注射阿片类药物（ITOs），如吗啡、芬太尼和舒芬太尼，被广泛用作剖宫产脊髓麻醉的辅助药物，以增强术后镇痛效果并减少全身阿片类药物的暴露。优化它们的选择和剂量对于平衡有效的镇痛效果与母婴安全至关重要。本文旨在批判性地分析鞘内注射阿片类药物在剖宫产脊髓麻醉中的应用，重点关注其作用机制、临床益处、相关风险以及在加速康复外科（ERAS）方案中的作用。使用PubMed、Scopus和谷歌学术进行了一项全面的叙述性综述，以识别2010年1月至2025年3月30日期间发表的相关文献。吗啡可提供长时间的术后镇痛，但与较高的瘙痒发生率和延迟性呼吸抑制有关。芬太尼和舒芬太尼起效更快，但镇痛持续时间较短。将鞘内注射阿片类药物与局部麻醉剂联合使用可改善血流动力学稳定性并减少总体阿片类药物需求量。虽然不良反应很常见，但它们是剂量依赖性的，通过适当的监测是可控的。根据药理学特征和患者特定因素进行鞘内注射阿片类药物的个体化选择，可增强剖宫产分娩中的镇痛效果和患者特定安全性。完善给药策略并整合多模式镇痛方案对于将不良反应降至最低并优化母婴结局至关重要。
