Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study

Assessment of the Association Between Neuraxial Anesthesia and Back Pain After Delivery: A Systematic Review and Meta-Analysis

Background: Back pain after delivery both under cesarean section and spontaneous vaginal delivery is the most common pregnancy-related musculoskeletal problem. There are multiple studies that emphasize the effect of epidural anesthesia and spinal anesthesia on the incidence and severity of postdelivery back pain. There are others stating no association between the two. Objective: The aim of this study is to summarize the relationship between back pain after delivery and neuraxial anesthesia. Methods: Studies identified from database: Cochrane Library, The Virtual Health Library, National Library of Medicine PubMed, Google Scholar, and citation searching with both experimental and observational study design were included. Exposed and nonexposed incidence of back pain was extracted to analyze the pooled odds ratio assessing the association of postpartum back pain and neuraxial anesthesia. Heterogeneity was checked across studies using Cochrane Q test statistic and I 2. Small study effect was assessed using a funnel plot graphically and nonparametric rank correlation (Begg) test. Results: Four RCT and 11 observational studies were identified for analysis. The studies included mothers delivering under cesarean section and vaginal delivery with epidural anesthesia, spinal anesthesia, and combined spinal epidural anesthesia. Based on the 15 studies included in this meta-analysis, the pooled odds ratio according to random effect restricted maximum-likelihood model was 1.2 (95% CI (0.77-1.86)) with p value = 0.43. There was a significant heterogeneity with I 2 = 97.76%, H 2 = 44.58, and Cochrane Q statistics p value = 0.001. Conclusion: Our result suggests neuraxial anesthesia may not be the cause or the risk factor for the overwhelmingly high incidence of back pain women experience after delivery.

Chronic pain after cesarean delivery: what do we know today? A narrative review

Childbirth is a major event in life, associated with both physical and psychological changes which may affect women's quality of life. Cesarean delivery (CD) is among the most frequent surgical procedures performed worldwide. Because of the high CD volume and patients' vulnerability (young age and female sex), for chronic postsurgical pain (CPSP), the societal impact of chronic pain after CD requires attention. According to the literature, the incidence of CPSP after CD is highly variable but reasonable evidence suggests a low incidence at six months (3-4%) and later (0.6-0.8%). The recent definition of CPSP in the ICD-11 coding system may not necessarily apply to the specific context of childbirth and CPSP after CD, suggesting that some modifications could be implemented. Interestingly, the incidence of chronic pain after CD is lower than that observed after gynecologic procedures performed in the similar body area. Consequently, since the risk factors do not really differ from those reported for other procedures, the existence of protective factors related to hormonal modulations secondary to pregnancy and lactation have been suggested. Such observations, in preclinical models, also question the pathophysiology of chronic pain after childbirth. Because severe acute postpartum pain is a striking risk factor of CPSP after CD, the preventive effect of different analgesic treatments, mainly regional analgesia techniques, has been evaluated but the results remain disappointing. In conclusion, many questions remain regarding the incidence, pathophysiology and potential prevention of CPSP after CD, and these questions warrant further research.

From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.

Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study

BACKGROUND

Unresolved postpartum LBP may affect women...s physical and psychological health.

AIM

To investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.

METHOD

Postpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.

RESULTS

In all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.

CONCLUSIONS

For postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.

Decreased Risk of Low Back Pain During Pregnancy Associated With the Use of Orthopedic Manual Therapy: A Nested Case-Control Study

Background

Recent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy.

Methods

From Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20–55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly diagnosed LBP were matched to 3,846 controls according to age and cohort entry year. Multivariate conditional logistic regression was employed to estimate the association between OMT use before pregnancy and LBP during pregnancy.

Results

OMT users had a lower risk of LBP than did non-users, with an adjusted OR of 0.86 (95% CI, 0.78–0.93). Subgroup analysis showed that women with high intensity use of OMT treatment prior to pregnancy reported the lowest level of LBP during pregnancy by nearly 30%.

Conclusion

The pre-pregnancy use of OMT treatment significantly decreased LBP risk during pregnancy, especially with high-intensity use. Thus, clinicians may consider recommending OMT for pregnant women to avoid possible obstetric complications during the pregnancy.

The Incidence of and Risk Factors for Localized Pain at the Epidural Insertion Site After Epidural Anesthesia: A Prospective Survey of More Than 5000 Cases in Nonobstetric Surgery

Background

This prospective research aimed to determine the incidence of and risk factors for localized pain at the epidural insertion site following nonobstetric surgery performed with epidural anesthesia.

Methods

A total of 5083 surgical inpatients at the teaching hospital undergoing epidural anesthesia were included in the study. The characteristics of the patients, preoperative basic diseases, details of the epidural techniques, surgical procedures and complications were recorded pre-anesthesia until the complications resolved. Multivariate logistic regression analysis was performed to identify predictors of localized pain at the epidural insertion site.

Results

In our analysis, target complications were reported in 532 (10.5%) patients; localized pain at the epidural insertion site occurred in 460 (9.05%) patients, while other major complications occurred in 72 (1.45%) patients. A total of 334 patients had mild pain, and 126 patients had moderate pain. The incidence of localized pain at the epidural insertion site was highest among all complications, and the identified risk factors in the multivariate analysis were as follows: lumbar insertion (odds ratio, 1.77; 95% CI 1.33–2.35), age less than 50 years old (odds ratio, 1.56; 95% CI 1.29–1.89), multiple block attempts (odds ratio, 3.39; 95% CI 2.68–4.31), and postoperative patient-controlled epidural analgesia (odds ratio, 0.46; 95% CI 0.33–0.63).

Conclusion

Localized pain at the epidural insertion site is the most common complaint after epidural anesthesia and requires adequate clinical attention. Improving the proficiency of anesthesiologists to avoid repeated punctures is the best way to reduce injuries.

Incidence of low back pain and potential risk factors among pharmacists: A population-based cohort study in Taiwan

Low back pain (LBP) is one of the most common symptoms of work-related musculoskeletal disorders in pharmacists. This can impede the physical functions of the body and lead to incapacitation, resulting in significant social and economic burden. This study aimed to investigate the incidence and risk factors that correlate with LBP in Taiwanese pharmacists.A retrospective cohort study was conducted among all registered pharmacists aged 20 to 40 years using the National Health Insurance Research Database (2000-2013) in Taiwan. The LBP diagnosis was confirmed with one episode of hospitalization or at least three claimed outpatient visits for LBP. Data on workplace characteristics as well as comorbidities were also collected for the analyses. A Cox proportional hazard regression was used to estimate the risk factors for LBP.The incidence rate of LBP among pharmacists was 16.60% in this study. Older pharmacists (28.49%; P < .01) and those who worked at district hospitals (23.51%; P < .01) showed a higher proportion of LBP. Furthermore, after adjustment for selected potential confounding factors, female pharmacists [adjusted hazard ratio (aHR): 1.12, 95% confidence interval (95% CI): 1.01-1.24, P = .0354] and pharmacists with diabetes (aHR: 1.55; 95% CI: 1.20-2.01; P = .0008) and gout (aHR: 1.70; 95% CI: 1.37-2.09; P < .0001) had significantly higher risks of LBP.In conclusion, age was positively correlated with LBP, and the workplace was an important factor in the development of LBP in pharmacists. We suggest that pharmacists who work in district hospitals should pay more attention to the development of LBP.

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.

Impact of Pregnancy on Loss of Deformity Correction After Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis

OBJECTIVE

A retrospective multicenter comparative study was carried out to evaluate whether pregnancy leads to the loss of deformity correction (LOC) in female patients surgically treated for idiopathic scoliosis.

METHODS

A total of 128 female patients who underwent segmental spinal instrumentation and fusion for adolescent idiopathic scoliosis (AIS) between 1999 and 2014 were reviewed. Of these patients, 62 became pregnant (surgery-pregnancy group [SPG]), whereas 66 did not (surgery-nonpregnancy [SNP] group). Radiographic parameters were analyzed before surgery, after surgery, before pregnancy, up to 1 year after delivery, and at final follow-up (FFU). Health-related quality of life was analyzed using the Scoliosis Research Society outcome questionnaire (SRS-22r).

RESULTS

The mean age at the time of surgery was 16 years in both groups. The mean preoperative major curves were 65° (standard deviation [SD], 12°) versus 67° (SD, 11°), 18° (SD, 9°) versus 17° (SD, 9°) immediately after surgery, and 20° (SD, 8°) versus 20° (SD, 8°) at FFU in the SPG and SNP groups, respectively (P > 0.10 for all comparisons). The mean loss of correction was 3.5° (SD, 3°) in the SPG and 4.5 (SD, 3°) for SNP groups, respectively (P = 0.379). The mean preoperative thoracic kyphosis (T5-T12) was 26.5° (SD, 11.9°) for SPG and 24.7° (SD, 14.5°) for SNP, after surgery 19.2° (SD, 9.5°) for SPG, 18.8 (SD, 8.9°) for SNP and at FFU, 20.3° (SD, 9°) for SPG and 21.3° (SD, 8.5°) for SNP.

CONCLUSIONS

Women who have undergone pedicle screw instrumentation and fusion who have had ≥1 pregnancies do not have curve progression or deterioration in the longer-term outcomes compared with patients who have not become pregnant.

Factors associated with persistent pain after childbirth: a narrative review

A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted. Factors strongly and specifically associated with persistent incisional scar pain after Caesarean delivery include a coexisting persistent pain problem in another part of the body and severe acute postoperative pain. For persistent vaginal and perineal pain, operative vaginal delivery and the magnitude of perineal trauma have been consistently linked. History of pregnancy-related and pre-pregnancy back pain and heavier body weight are robust risk factors for persistent back pain after pregnancy. Unfortunately, limitations, particularly small samples and lack of a priori sample size calculation designed to detect specific effect sizes for risk of persistent pain outcomes, preclude definitive conclusions about many other predictors and the strength of outcome associations. In future studies, assessments of specific phenotypes using a rigorous analysis with appropriate predetermined sample sizes and validated instruments are needed to allow elucidation of stronger and reliable associations. Interventional studies targeting the most robustly associated, modifiable risk factors, such as acute post-partum pain, may lead to solutions for the prevention and treatment of these common problems that impact a large population.

The prevalence of first-onset temporomandibular disorder in low back pain and associated risk factors: A nationwide population-based cohort study with a 15-year follow-up

The coexistence of low back pain (LBP) and temporomandibular disorder (TMD) has often been noted clinically. However, studies of the association between these two conditions involving a large population with longitudinal evidences are lacking. Therefore, the study aimed to investigate the association between LBP and TMD in a nationwide-matched cohort population with a 15-year follow-up.Data of 65,121 patients newly diagnosed with LBP were analyzed, along with those of 195,363 (1:3) sex- and age-matched controls. Multivariate Cox regression analysis was used to determine TMD risk between the LBP and non-LBP groups. Kaplan-Meier method was used for determining the cumulative risk of first-onset TMD between groups, with a 15-year follow-up.The LBP group was more likely to develop first-onset TMD (adjusted hazards ratio (HR) = 1.561, P < .001), after adjusting for demographic variables and comorbidities. The risk factors for TMD were LBP, young age, higher insured premium, and osteoporosis. In the subgroup analysis, the LBP group had a higher risk of TMD than the non-LBP group in all stratifications.LBP is the risk factor contributing to the development of first-onset TMD. Therefore, clinicians should be reminded to manage LBP disorders concurrently when treating TMD.

Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study

The purpose of this study was to analyze the relationship between elevated cardiovascular disease (CVD) risk and type of anesthesia by using the National Health Insurance Research Database (NHIRD) of Taiwan in a one-year follow-up period. We assessed whether general anesthesia (GA) or neuraxial anesthesia (NA) increased CVD occurrence in lower-limb fracture patients. Approximately 1 million patients were randomly sampled from the NHIRD registry. We identified and enrolled 3437 lower-limb fracture patients who had received anesthesia during operations conducted in the period from 2010 to 2012. Next, patients were divided into two groups, namely GA (n = 1504) and NA (n = 1933), based on the anesthetic technique received during surgery. Our results revealed that those receiving GA did not differ in their risk of CVD relative to those receiving NA, adjusted HR = 1.24 (95% CI: 0.80–1.92). Patients who received GA for more than 2 h also did not differ in their risk of CVD relative to those receiving NA for less than 2 h, adjusted HR = 1.43 (95% CI: 0.81–2.50). Moreover, in the GA group (i.e., patients aged ≥65 years and women), no significant difference for the risk of CVD events was observed. In conclusion, in our study, the difference in the risk of CVD between lower-limb fracture patients receiving NA and GA was not statistically significant. The incidence rate of CVD seemed to be more correlated with patients’ underlying characteristics such as old age, comorbidities, or admission to the intensive care unit. Due to the limited sample size in this study, a database which reviews a whole national population will be required to verify our results in the future.

Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial

BACKGROUND

Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.

METHODS

This was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.

RESULTS

No parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups.

CONCLUSIONS

Minimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.

TRIAL REGISTRATION

This study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).

Back Pain and Outcomes of Pregnancy After Instrumented Spinal Fusion for Adolescent Idiopathic Scoliosis

OBJECTIVE

We hypothesized that women undergoing scoliosis surgery who became pregnant would go to full term, have uncomplicated pregnancies, and similar patient-reported outcome measures than non-pregnant patients and healthy controls.

METHODS

Two hundred five women with adolescent idiopathic scoliosis (AIS) undergoing scoliosis surgery between 1998 and 2015 at several institutions in 1 country and 173 healthy women, without AIS, parous and nulliparous, were selected at random.

RESULTS

One hundred eight women with scoliosis surgery and no pregnancy (SNP), 97 women with scoliosis surgery and pregnancy (SP), 91 healthy controls and no pregnancy, and 82 healthy controls and pregnancy (HP) were reviewed. Mean follow-up was 5 years in the SNP, 6 years in the SP, 5 years in the healthy controls and no pregnancy, and 5 years in the HP. The average time from surgery to childbirth was 5 years. Back pain (BP) during pregnancy was observed in 48% of the SP and 34% of the HP. BP after childbirth was present in 43% of the SP and 42% of the HP. Patients fused to L3 or L4 experienced more frequent low BP during pregnancy (40%) than those fused above L3 (P < 0.05). Cesarean section (CS) was performed for 64% and 33% in SP and HP, respectively (P < 0.05). As the lowest instrumented vertebra moved caudal to L4, the frequency of CS increased (P < 0.05; R = 0.8). The majority of CS in SP were performed in patients fused to L4 (55%) versus patients fused above and to L3 (45%) (P < 0.05). The most common analgesia for CS was spinal block (75% in SP and 86% in HP). Patients fused to L4 required general anesthesia significantly more often (7%) versus those fused above L4 (4%, P < 0.05). The health-related quality of life after spinal fusion showed general satisfaction and were similar for SNP and SP (mean 3.84 and 3.91, respectively). No sexual dysfunction was reported.

CONCLUSIONS

Women with a history of spinal fusion for AIS fused to L3 or L4 reported a higher incidence of low BP, and CSs are more frequently required. This risk increased to 55% when spinal fusion to L4 was performed. The quality of life and sexual function were at the same level in women after scoliosis surgery than in healthy controls.

Back pain in pregnancy among office workers: risk factors and its impact on quality of life

Background Back pain is a common presenting complaint during pregnancy and it is often being considered as part of the pregnancy process. The purpose of the study is to investigate the prevalence of back pain in pregnancy, risk factors and its impact on the quality of life in pregnant women. Materials and methods Three hundred and fifty-eight pregnant women who attended the antenatal clinic in Universiti Kebangsaan Malaysia (UKM) Medical Centre were recruited in this cross-sectional study from October 2011 until April 2012. The back pain was further classified into lumbar pain and posterior pelvic pain. The severity of back pain was assessed using visual analoque scale (VAS) and the functional limitation was assessed using the Oswestry Disability Questionnaire (ODQ). Result The prevalence of back pain in pregnancy was 84.6%. Occupation and previous history of back pain were associated with back pain in pregnancy. In terms of functional limitation disability, total ODQ score was statistically significant correlate with severity of pain (VAS score). Personal care, sitting, standing, sex life and social life were significantly affected. Conclusion The risk factors for back pain in pregnancy were type of occupation and history of back pain. The higher VAS score, the more ODQ will be affected. Personal care, sitting, standing, sex life and social life were significantly affected.

Effects of Korean hand acupressure on opioid-related nausea and vomiting, and pain after caesarean delivery using spinal anaesthesia

OBJECTIVE

This study examined the effects of Korean hand acupressure on opioid-related nausea and vomiting, and pain after caesarean delivery.

METHODS

Fifty participants were randomly assigned to an acupressure group or a control group. Korean hand acupressure discs were applied for 24 h onto 12 acupressure points (K-9, F-4 for nausea and vomiting; M-3, M-4, L-4, H-2, H-3, H-7 for abdominal pain; and I-38, J-2 for back pain). Nausea and vomiting incidences, the opioid-related symptom distress scale scores, and pain scores were analysed using chi-square test, Fisher's exact test, Mann-Whitney U test, or the repeated-measures analysis of variance.

RESULTS

The acupressure group had lower incidences of nausea and vomiting, as well as significant improvements in the opioid-related symptom distress scores for nausea, vomiting, and pain. The acupressure group required fewer rescue antiemetics and analgesics.

CONCLUSION

Korean hand acupressure can relieve nausea and vomiting, as well as pain after caesarean delivery.