Opioids are the most popular class of drugs used for post-cesarean analgesia. They are very useful in the treatment of somatic pain. The use of morphine, diamorphine, fentanyl, sufentanil, meperidine, nalbuphine, and buprenorphine is well documented. Various opioids differ in potency and severity of side effects. A discussion of the merits and demerits of each is beyond the scope of this article. Common minor side effects include nausea, vomiting, itching, chills, and urinary retention. Respiratory depression, especially with late onset, is a most feared complication. ROUTE OF ADMINISTRATION OF OPIDS CENTRAL NEURAXIAL – INTRATHECAL / EPIDURAL Intrathecal opioids exert an analgesic action by acting on the μ receptors of the spinal cord. The onset and duration of action depend on fat solubility. Fat-soluble opioids such as fentanyl and sufentanil diffuse more from the cerebrospinal fluid into neural tissue. This results in a quicker onset and shorter duration of action than less lipid-soluble opioids such as morphine, diamorphine, and buprenorphine. However, sufentanil has a longer duration of action than fentanyl due to its greater affinity for μ receptors. Very small amounts of opioids are required via the central neuraxial route compared to larger doses required systemically. Therefore, secretion in breast milk is not a cause for concern.5. Intrathecal morphine is the gold standard for post-cesarean analgesia. Palmer et al.6 found a maximal analgesic effect with intrathecal doses of morphine greater than 75 μg. Higher doses increased the severity of itching, while other common opioid-related side effects, such as nausea and vomiting, had no dose-dependent relationship. They suggest an intrathecal dose of 0.1 mg… center of paper… the epidural space contains a large venous plexus that swells during pregnancy. Therefore, intravascular reabsorption of opioids after epidural administration is extensive. Although epidural doses of opioids are higher than those administered intrathecally, they are still safe during breastfeeding12. Data from a dose-response study by Palmer et al.13 indicate that the degree and duration of epidural morphine analgesia increases with a dose-related manner from 0 to 3.75 mg. A single bolus dose provides good analgesia for the first 24 hours. An extended-release formulation EREM (extended-release epidural morphine) is also available. Shorter-acting opioids such as fentanyl (2 mcg/ml) and sufentanil (0.8 mcg/ml) are used in nurse-controlled or patient-controlled epidural analgesia (PCEA) techniques in association with low-pressure local anesthetic agents. dosage.