Optimizing Multimodal Post-Cesarean Analgesia: A Structured Narrative Review of Neuraxial Morphine, Systemic Adjuvants, and Regional Fascial Plane Blocks

Objective: This structured narrative review evaluates contemporary approaches to post-cesarean pain management, analyzing low-dose neuraxial opioids as the reference standard, scheduled nonopioid systemic baselines, and regional fascial plane blocks within the context of Enhanced Recovery After Surgery (ERAS) pathways and society guidelines. Mechanism: The analgesic modalities reviewed target distinct post-cesarean pain pathways: scheduled nonopioids provide synergistic central and peripheral baseline relief, neuraxial opioids act directly on spinal dorsal horn mu-receptors to control deep visceral and somatic pain, and fascial plane blocks anesthetize targeted peripheral nerves of the anterior abdominal wall. Findings in Brief: Synthesized evidence confirms that scheduled nonopioid baseline regimens reduce postoperative opioid requirements by 30% to 40%. Low-dose intrathecal morphine (ITM) remains the gold standard for post-cesarean analgesia. Advanced fascial plane blocks serve as vital secondary alternatives or adjuncts when neuraxial opioids are omitted or contraindicated. Global guidelines from 2019 to 2026 consistently prioritize low-dose neuraxial morphine as the baseline standard, reserving regional blocks for targeted incisional analgesia. Current literature remains limited by a lack of diverse clinical data from low- and middle-income countries (LMICs) with restricted ultrasound infrastructure. Conclusions: Optimal post-cesarean analgesia is best achieved through a scheduled nonopioid foundation combined with low-dose neuraxial morphine. Advanced regional fascial plane blocks provide valuable targeted incisional analgesia and serve as essential secondary options when central neuraxial analgesia cannot be administered.