[Incidence and predisposing factors of persistent backache after lumbar catheter epidural anesthesia in a non-obstetrical settingø]

Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia

Background

The effects of anesthetic techniques on postdural puncture backache (PDPB) have not been specifically evaluated. The purpose of this study was to compare the incidence and severity of PDPB between median and paramedian techniques.

Methods

Patients were randomized to receive spinal anesthesia by either a median (Group M, n = 50) or paramedian (Group P, n = 50) approach.We recorded each patient’s personal number of puncture attempts, surgical position, and operation duration. We investigated the incidence and intensity of back pain 1 day, 1 week, and 1, 2, and 3 months postoperatively.

Results

The overall incidence of PDPB was higher in the Group M (18/50, 36%) than in the Group P (8/50, 16%) (P = 0.023). Twenty-four hours after surgery, 8 patients in Group M and 6 patients in Group P complained of back pain. Seven days after the surgery, 16 patients in the Group M and 5 patients in the Group P complained of pain (P = 0.007). After 1 month, 5 patients in the Group M and 1 patient in the Group P complained of pain. Only one patient in each group complained of pain after 3 months. No significant differences were noted in NRSs between the groups during study period.

Conclusions

The results of this study suggest that spinal anesthesia using the paramedian approach reduces the incidence of PDPB during the early postoperative period.

Incidence and Factors Contributing to Low Back Pain in the Nonobstetrical Patients Operated Under Spinal Anesthesia: A Prospective 1-Year Follow-Up Study

PURPOSE

To determine the incidence and factors contributing to postspinal anesthesia (SPA) low back pain (LBP) in patients undergoing nonobstetrical surgeries.

DESIGN

A prospective 1-year follow-up study.

METHODS

Patients having nonobstetrical surgery using SPA were included. The patients were followed up through phone calls and interviews every postoperative day for the first week, weekly for a month, and then monthly for a year after SPA. Patients' duration of LBP, duration of surgery, and need for LBP treatment were recorded.

FINDINGS

Of 410 patients, 5.8% (24 patients) experienced LBP. The incidence of LBP did not have a significant correlation with the recorded variables (P > .05). There was a negative significant correlation between duration of LBP and duration of surgery (r = -0.5096; P = .001). Of the 24 patients experiencing LBP, 16.7% (four patients) experienced it for less than 1 day, 66.7% (16 patients) 1 to 7 days, 16.7% (four patients) more than 7 days, and only one patient (4.2%) for up to 17 days. Special LBP treatment was not needed in any of the patients.

CONCLUSIONS

The incidence of LBP was very low, and those patients undergoing nonobstetrical surgery and receiving SPA did not experience persistent LBP.

Incidence of self-limiting back pain in children following caudal blockade: an exploratory study

BACKGROUND

Currently, in pediatric anesthesia, there is no evidence-based information available to pediatric patients and their parents regarding the incidence of back pain after neuraxial injections performed for postoperative analgesia. Back pain postepidural blockade has been reported in numerous studies with adult patients; however, it has not been investigated in children. The main objective of this study is to examine the incidence of back pain symptoms after caudal blockade (early and late onset) in children.

METHODS

Patients under the age of 18 years, who received caudal blockade at the Montreal Children's Hospital between July 2006 and December 2008 were recruited in this prospective observational study. Back pain was measured prospectively by patient self-report and parental observation during the 15-day postoperative period. Patients, or their parents, were contacted by phone on postoperative day 2 (POD2) and postoperative day 15 (POD15) to answer a seven-item symptom questionnaire.

RESULTS

In a sample of 135 children, the incidence of back pain symptoms was 4.7% and 1.1% on POD2 and POD15, respectively.

CONCLUSIONS

The results of this study provide support that transient self-limiting back pain after caudal blockade does occur in pediatric patients. Clinically, this is useful information for physicians to provide to their patients. An exploration of factors that may be associated with back pain following caudal blockade in children is an interesting area of future research.

Spinal anesthesia with isobaric tetracaine in patients with previous lumbar spinal surgery

PURPOSE

Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated.

MATERIALS AND METHODS

Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed.

RESULTS

The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028).

CONCLUSION

The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.

Effects of dexmedetomidine on the duration of anaesthesia and wakefulness in bupivacaine epidural block

BACKGROUND

The purpose of this study was to examine the effects of intravenous dexmedetomidine on the duration of bupivacaine-induced epidural anaesthesia and level of wakefulness and the respective side-effects.

METHODS

Sixty ASA I-II patients were included in the study. Consecutive patients were allocated to groups according to the last digit (odd/even) of their admission numbers. All patients had epidural anaesthesia with bupivacaine 0.5% performed by the same experienced anaesthesiologist. In the first group, the patients were administered intravenous dexmedetomidine infusion just after the epidural block and continued during the operation, while those in the second group were administered physiologic saline infusion at the same amount and duration.

RESULTS

The recovery time of sensory block was significantly longer in the first group. The bispectral index values were lower in the first group than in the second. Also, heart rate was significantly lower in Group I than in Group II. Regarding side-effects, shivering was significantly less frequent in the first group, whereas there was a significant increase in the requirement of atropine in the first group as dexmedetomidine caused bradycardia.

CONCLUSION

Intravenous administration of dexmedetomidine prolonged the duration of epidural anaesthesia, provided sedation and had few side-effects.

Persistent back pain after spinal anaesthesia in the non-obstetric setting: incidence and predisposing factors

We determined the incidence of persistent back pain (PBP) after non-obstetrical spinal anaesthesia (SPA) and investigated factors predisposing to such pain in a prospective 1 yr follow-up study in 245 patients undergoing elective general or trauma surgery (218 patients undergoing single SPA, 27 undergoing two to six SPAs). All patients received a first questionnaire 3 months after the last SPA, and those reporting PBP after 3 months were sent a second questionnaire I year after the operation. Variables were PBP before and within 5 days, at 3 months and I year after SPA, patient satisfaction with SPA, patient characteristics and technical data. Statistical analysis was by contingency tables with Fisher's exact test and an unpaired t-test with logistic regression (P < 0.001 after Bonferroni correction was taken as significant). The response rate in patients who had a single SPA was 56% (122/218). Twenty-three of these 122 patients (18.9%) complained of back pain before SPA compared with 12/122 (10.7%, P = 0.0015) within 5 days after SPA. After 3 months, 15/122 patients (12.3%) reported PBP with 14 complaining of PBP before SPA (P < 0.0001), corresponding to an incidence of new PBP of 1/122 (0.8%). Multiple logistic regression revealed that pre-existing back pain was the only variable associated with PBP after 3 months (P < 0.0001). Patient characteristics and technical factors were not associated with PBP. Nine of the 15 patients with PBP after 3 months returned the second questionnaire: four still reported PBP (three of these had suffered from PBP before SPA). Despite PBP after 3 months, 13/15 patients said they would opt for SPA again. The response rate and results in patients who had had multiple SPAs were similiar to those who had had a single SPA.