BACKGROUND Butorphanol, an opioid receptor agonist and antagonist, is widely used for post-cesarean section analgesia in the form of intravenous or intramuscular injection, but nasal sprays are less used. This study aimed to evaluate the analgesic effect of butorphanol nasal spray on uterine contraction pain after cesarean section and explore its effect on postpartum prolactin secretion. MATERIAL AND METHODS We randomly divided 120 patients scheduled for cesarean section into 3 groups (40 per group): intranasal saline (control), butorphanol intranasal (BI), and butorphanol pumped intravenously (BV). The same analgesic pump protocol was used in all groups. The visual analog scale (VAS) and Ramsay sedation scale (RASS) were used to evaluate analgesic and sedation levels 6, 12, and 24 h postoperatively. We recorded the start time of breastfeeding, number of PCIA presses, consumption of butorphanol, and preoperative and postoperative serum prolactin levels. RESULTS At 6 h postoperatively, the BI and BV groups had lower VAS and higher RASS (P<0.05) than the control group, no difference between the BI and BV groups, but the consumption of butorphanol was lower in the BI group (P<0.05). The analgesic and sedative effects in the BI group were lower than those in the BV group at 12 h (P<0.05). No difference in the start time of breastfeeding, serum prolactin levels among the 3 groups (P>0.05). CONCLUSIONS Patients may prefer butorphanol tartrate nasal spray because they can obtain satisfactory analgesia in the early postoperative period, with high non-invasive comfort and reduced use of opioids. No effect on prolactin levels or lactation initiation was observed.