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Background Severe acute pain occurs in more than 10% of patients within the first 36 h after a cesarean section and can significantly impact women's satisfaction. The aim of this study was to compare the transversus abdominis plane (TAP) block for postoperative pain relief following cesarean section operations with the most famous analgesia (intrathecal morphine) used for a cesarean section regarding its efficacy and complications. Patients and methods This interventional double-blinded randomized controlled study was carried out on 60 cases, who underwent an elective cesarean delivery. They were randomized into two groups; patients were divided into two equal groups. Group M received intrathecal 150 μg morphine in a 0.5 ml volume, mixed with 10 mg of hyperbaric bupivacaine 0.5% in a 2 ml volume (total volume 2.5 ml). Group B received intrathecal 10 mg hyperbaric bupivacaine 0.5% 2 ml volume+0.5 saline (total volume 3 ml) and at the end of surgery the patient received bilateral TAP block with a 20 ml volume of 0.25% bupivacaine on each side. Results Postoperative heart rate, respiratory rate, oxygen saturation, mean arterial blood pressure, and intraoperative Bromage score were insignificantly different at all-time measurements between both groups. Visual analog score and postoperative Bromage score at 2, 3, and 4 h were higher in group B than group M (P<0.001). Time of rescue analgesia was significantly prolonged in group M than group B (P<0.001). Total paracetamol and morphine doses were significantly lower in group M than group B (P<0.001). Conclusions TAP block is a good alternative technique to intrathecal morphine in reducing postcesarean section pain, with less postoperative nausea and vomiting and pruritus compared with intrathecal morphine (ITM). [ABSTRACT FROM AUTHOR]