<![CDATA[Background: Optimal postoperative pain management with minimal side effects is a crucial component of surgeries utilizing the Enhanced Recovery After Cesarean (ERAC) protocol. Neuraxial morphine is a major component of multimodal post-cesarean analgesia; however, high-dose administration increases the risk of specific adverse effects, including pruritus, nausea/vomiting, urinary retention, sedation, and respiratory depression. The addition of intrathecal fentanyl combined with a low dose of intrathecal morphine has been observed to be associated with favorable clinical outcomes. Case Series: This case series reports three female patients who underwent elective cesarean delivery under spinal anesthesia. The first and third cases received a combination of 10 mg bupivacaine, 25 mcg fentanyl, and 50 mcg morphine, whereas the second case received 10 mg bupivacaine and 100 mcg morphine. Postoperative evaluations for Cases 1 and 3 utilizing Wong-Baker FACES Pain Rating Scale (WBFS) ranging from 1 to 3 during the first 48 hours. Both patients were capable of sitting at the 6th hour and achieving independent mobilization by the 12th hour. Conversely, although the patient in Case 2 reported a WBFS of 1 to 2 within the first 48 hours, she experienced Post-Operative Nausea and Vomiting (PONV), which was associated with delayed mobilization (sitting at the 12th hour and mobilizing at the 18th hour). Conclusion: The addition of 25 mcg fentanyl combined with 50 mcg morphine was associated with a quality of postoperative analgesia that is not substantially different from 100 mcg of morphine in this case series. Furthermore, this regimen was observed to be associated with lower incidences of PONV and pruritus, as well as earlier mobilization of post-cesarean delivery patients.]]>
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