Evaluation of Acute and Chronic Back Pain After Spinal Anesthesia in Midline and Paramedian Approach: Incidence and Functional Disability

  • Mohammad Reza Khajavi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Alavi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Reza Shariat Moharari Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Etezadi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Farsad Imani Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: spinal anesthesia, back pain, midline, paramedian

Abstract

Background: The intensity of low back pain and functional disability in life is a common question of patients before spinal anesthesia. We aimed to compare acute and chronic back pain after spinal anesthesia in midline and paramedian approach.Methods: Two hundred twenty patients elective patients (25-65 year old) candidates for general, and urological surgery under spinal anesthesia, were allocated into the following two groups: Group M (midline) and Group P (paramedian). Spinal anesthesia was performed with hyperbaric bupivacaine 0.5% in the sitting position using a 25G Quincke needle in L3/L4 orL4/L5 level. During the operation, patients were placed in the supine position. The questionnaire assessed back pain and severity of pain with VAS score three days after spinal anesthesia. If the patients complained of back pain then, the effect of back pain on quality of life and the degree of patient's functional disability were assessed by Oswestry Disability Index on,45 and 90 days after surgery.Results: Forty-one patients (18%) had back pain after the operation, 22 patients were in the paramedian (54%) and 19 patients (46%) in the midline method of spinal anesthesia. (p=0.6). The mean intensity of back pain was 2.27vs1.45 (p=0.5) and the total number of mean functional disability index was less than five in both groups.Conclusion: The incidence of back pain was 18% and was not significantly different between the midline and paramedian methods. The severity of back pain decreased after three days, reaching to less than one on day the 45th and 90th, which does not affect daily patient’s functions.

References

Rhee WJ, Chung CJ, Lim YH, Lee KH, Lee SC. Factors in patient dissatisfaction and refusal regarding spinal anesthesia. Korean J Anesthesiol. 2010; 59(4):260-4.

Choi JG, In JY, Shin HI. Analysis of factors related to patient refusal of spinal anesthesia. Korean J Anesthesiol. 2009; 56(2):156–161.

Schwabe K, Hopf HB. Persistent back pain after spinal anesthesia in the non-obstetric setting: incidence and predisposing factors. Br J Anaesth. 2001; 86(4):535–539.

- Choi JS, Chang SJ. A Comparison of the Incidence of Post‐Dural Puncture Headache and Backache After Spinal Anesthesia: A Pragmatic Randomized Controlled Trial. Worldviews Evid Based Nurs. 2018; 15(1):45-53.

- Rafique MK, Taqi A. The causes, prevention and management of post spinal backache: an overview. Anaesthesia, Pain & Intensive Care. 2011; 15(1):65-9.

- Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000; 25(22):2940-52; discussion

- Hickmott KC, Healy TEJ, Roberts SP, Faraghart. Back pain following general anaesthesia and surgery: Evaluation of risk factors and the effect of an inflatable lumbar support. Br Journ Surgery. 1990:77(5):571-5.

- Salam AA, Afshan G. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2016; 32(1):94-98.

- Tekgül ZT, Pektaş S, Turan M, Karaman Y, Çakmak M, Gönüllü M. Acute Back Pain Following Surgery under Spinal Anesthesia. Pain Pract. 2015; 15(8):706-11.

- Etezadi F, Karimi Yarandi K, Ahangary A, Shokri H, Imani F, Safari S, et al. The Effect of Needle Type, Duration of Surgery and Position of the Patient on the Risk of Transient Neurologic Symptoms. Anesth Pain Med. 2013; 2(4):154-8.

- Pan PH, Fragneto R, Moore C, Ross V. Incidence of Postdural Puncture Headache and Backache, and Success Rate of Dural Puncture: Comparison of Two Spinal Needle Designs. South Med J. 2004: 97(4); 359-63.

- Rafique MK, Taqi A. The causes, prevention and management of post spinal backache: an overview. Anaesthesia, Pain & Intensive Care. 2011; 15(1):65-9.

- Bayındır S, Özcan S, Koçyiğit F, Hanbeyoğlu O. Which Approach is Preferred in Spinal Anesthesia: Median or Paramedian? Comparison of Early and Late Complications. Istanbul Medical J. 2017; 18(4):205-9.

- Schwabe K, Hopf HB. Persistent back pain after spinal anaesthesia in the non‐obstetric setting: incidence and predisposing factors. British J of anaesthesia. 2001; 86(4):535-9.

- Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008; 358(8):794-810.

- Roland M, Fairbank J. The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000; 25(24):3115-24.

Published
2018-09-11
How to Cite
1.
Khajavi MR, Alavi F, Shariat Moharari R, Etezadi F, Imani F. Evaluation of Acute and Chronic Back Pain After Spinal Anesthesia in Midline and Paramedian Approach: Incidence and Functional Disability. AACC. 4(4):535-7.
Section
Research Article(s)