Short term backache is a common problem in the first week after delivery and should not be confused with more chronic back problems. When questioned in the first few days after delivery, up to 45% of women report tenderness at the site of epidural needle insertion (1). A similar proportion of women in whom regional analgesia has not been used suffer from generalised lower backache following labour (2).
Long term backache after childbirth and its association with epidural analgesia in labour was highlighted in a retrospective study from the Birmingham Maternity Hospital (3). Long term backache was reported by 23% of women and, in 14% this had not been present before delivery. The incidence of new, long term backache was 18.9% in those who received epidural analgesia compared with 10.5% in those using other methods of pain relief in labour. Epidural anaesthesia for elective caesarean section did not produce an increased incidence of long term backache. It was, therefore, suggested that 'stressed' positions in labour exacerbated by muscular relaxation and the abolition of pain resulted in a postural backache. A second, retrospective study also demonstrated the association between epidurals and long term backache (4) (Figure 84.1). In most cases, backache was found to be postural, not severe and, usually, resolving.
In both these retrospective studies, the incidence of antenatal backache was significantly lower than that demonstrated in previous work conducted during pregnancy, in which backache was reported by 50% of these women. The more severe the antenatal backache, the longer it persisted after delivery. It would appear that, when questioned retrospectively, many women forget that they suffered from antenatal backache.
Recently performed prospective studies have failed to find an association between pain relief and long term backache (Figure 84.2). Backache was no more frequent after epidural or spinal analgesia compared with other forms of pain relief (5, 6, 7, 8) There was no relationship between the incidence of backache and the degree of motor block (7).
References:
2. Grove LH. Backache, headache, and bladder dysfunction after delivery. Br J Anaesth 1973; 45: 1147-1149.
6. Macarthur AJ, Macarthur C, Weeks S. Epidural anaesthesia and postpartum back pain. Anesthesiology 1993; 79: A973.
7. Russell R, Reynolds F. Long term backache after childbirth and motor block with epidural analgesia. Society of Obstetric Anesthesia and Perinatology 1995 Abstract Book p 100.
8. Fernando R, Patel M, Gill P, Urquhart J, Morgan B. A prospective study of long term backache after childbirth in primigravida -the effect of ambulatory epidural analgesia during labour. Society of Obstetric Anesthesia and Perinatology 1995 Abstract Book p51.