PREVALENCE AND FACTORS ASSOCIATED WITH POST-CESAREAN BACK PAIN IN WOMEN UNDERGOING SPINAL ANESTHESIA
Main Article Content
Keywords
Post-Cesarean, Back Pain, Spinal Anesthesia, Females
Abstract
Background: Spinal anesthesia (SA) is commonly preferred for various surgical procedures, including those involving the lower extremities, anorectal, urologic, obstetric, gynecologic, and lower abdominal areas. However, post spinal back pain (PSBP) is a notable complication associated with SA, more prevalent than with general anesthesia. Back pain is a widespread health issue affecting a significant portion of the global population, imposing considerable physical and economic burdens.
Objective: The objective of this study to assess the occurrence and determinants of post-cesarean back pain in women undergoing spinal anesthesia.
Methodology: This retrospective cohort study included 50 women who had undergone cesarean sections with spinal anesthesia at Al-Mubarak Hospital Sadiqabad. Data were extracted from medical records, encompassing demographic details, pain assessment, occupational status, previous medical history, and postoperative pain characteristics. Descriptive statistics, Chi-Square test, and Independent Sample t-test were employed for statistical analysis, with a p-value of less than 0.05 considered statistically significant.
Results: The study consisted predominantly young women with a mean age of 29.29 ± 2.44 years and a mean body mass index (BMI) of 24.38 ± 1.72. The cesarean sections were at 38.04 ± 0.80 weeks of gestation. Participants reported an average pain score of 6.06 ± 1.25, with a typical pain duration of 10.20 ± 2.73 hours. Regarding occupational status, 58% were employed, and 42% were unemployed. 18% had a history of previous abdominal operations, while all had undergone a previous C-section. Postoperative pain characteristics varied, with 36% reporting pain lasting less than one month. Pain intensity and frequency also varied, with significant associations between pain and maternal and surgical factors.
Conclusion: The study underscores the importance of procedural considerations, such as the number of lumbar puncture attempts and needle size, in determining the prevalence of post-cesarean back pain.
References
2. Shikur B, Marye A, Mesfin E. Spinal anesthesia for cesarean delivery at two teaching hospitals in Addis Ababa, Ethiopia. Ethiop med j(Online). 2018:133-40.
3. Lee JS. Spinal anesthesia: how can we improve patient satisfaction? Korean journal of anesthesiology. 2010;59(4):231-2.
4. Patel VB, Wasserman R, Imani F. Interventional therapies for chronic low back pain: a focused review (efficacy and outcomes). Anesthesiology and pain medicine. 2015;5(4).
5. Williams J, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T. & Chatterji, S.(2015). Risk factors and disability associated with low back pain in older adults in low-and middle-income countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE). PLoS One.10(6):e0127880.
6. Bekele Z, Ayana M, Haile M, Tesfaye A, Tasew A. Incidence and predictors of postoperative severe acute pain within 24 hours after cesarean section performed under spinal anesthesia at public hospitals in West Shoa, Ethiopia, 2022 prospective cohort study. Annals of Medicine and Surgery. 2023;85(9):4239-47.
7. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. The lancet. 2012;379(9814):482-91.
8. Badoni S, Bhatt H, Palaria U, Gupta N. Study of the incidence of post dural puncture headache (pdph) and post dural puncture backpain (PDPB) in post cesarean female. International Journal Academic Medical Pharmacy. 2023;5(3):1062-5.
9. Rhee WJ, Chung CJ, Lim YH, Lee KH, Lee SC. Factors in patient dissatisfaction and refusal regarding spinal anesthesia. Korean journal of anesthesiology. 2010;59(4):260-4.
10. Brooks RR, Oudekerk C, Olson RL, Daniel C, Vacchiano C, Maye J. The effect of spinal introducer needle use on postoperative back pain. AANA journal. 2002;70(6).
11. Stanisic DM, Kalezic N, Rakic A, Rajovic N, Mostic TI, Cumic J, et al. Comparison of post-cesarean pain perception of general versus regional anesthesia, a single-center study. Medicina. 2022;59(1):44.
12. Haghighi M, Mardani Kivi M, Mohammadzadeh A, Etehad H, Soleymanha M, Mirbolook A. Evaluation of correlative factor of backache and headache after spinal anesthesia in orthopedic surgery. Journal of Guilan University of Medical Sciences. 2012;21(82):31-8.
13. Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Revista de saude publica. 2015;49.
14. Benzon HT, Asher YG, Hartrick CT. Back pain and neuraxial anesthesia. Anesthesia & Analgesia. 2016;122(6):2047-58.
15. Yirgu AN, Weyessa AB. Prevalence and risk factors of acute backache after spinal anesthesia in surgical procedures at asella teaching and referal hospital, asella, Ethiopia. International Journal of Medicine and Medical Sciences. 2019;11(1):1-10.
16. Rafique MK, Taqi A. The causes, prevention and management of post spinal backache: an overview. Anaesth Pain Intensive Care. 2011;15(1):65-9.
17. Mohtadi AR, Chegeni AA, Behaeen K, Savaie M, Ghomeishi A. Post-cesarean Delivery Analgesia Using Spinal Anesthesia: Ropivacaine-Fentanyl vs. Ropivacaine-Sufentanil. Anesthesiology and Pain Medicine. 2023;13(4).
18. 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. Southern medical journal. 2004;97(4):359-64.
19. Duits FH, Martinez‐Lage P, Paquet C, Engelborghs S, Lleo A, Hausner L, et al. Performance and complications of lumbar puncture in memory clinics: results of the multicenter lumbar puncture feasibility study. Alzheimer's & Dementia. 2016;12(2):154-63.
20. Ebinger F, Kosel C, Pietz J, Rating D. Headache and backache after lumbar puncture in children and adolescents: a prospective study. Pediatrics. 2004;113(6):1588-92.
21. Ozturk Inal Z, Gorkem U, Inal HA. Effects of preoperative anxiety on postcesarean delivery pain and analgesic consumption: general versus spinal anesthesia. The Journal of Maternal-Fetal & Neonatal Medicine. 2020;33(2):191-7.
22. Gao W, Ren Y, Cui GX. Dexamethasone added to local lidocaine for infiltration along the spinal-epidural needle pathway decreases incidence and severity of backache after gynecological surgery. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2015;21:821.
23. Makoko UM, Modiba LM, Nzaumvila DK. Satisfaction with spinal anaesthesia for Caesarean section at Tembisa Hospital, South Africa: a cross-sectional study. South African Family Practice. 2019;61(2):39-47.
24. Al-Husban N, Elmuhtaseb MS, Al-Husban H, Nabhan M, Abuhalaweh H, Alkhatib YM, et al. Anesthesia for cesarean section: retrospective comparative study. International Journal of Women's Health. 2021:141-52.
25. Kumar KH, Elavarasi P. Definition of pain and classification of pain disorders. Journal of Advanced Clinical and Research Insights. 2016;3(3):87-90.
26. Cook T, Counsell D, Wildsmith J. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British journal of anaesthesia. 2009;102(2):179-90.
27. Lee JH, Yoon DH, Heo BH. Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia. Korean Journal of Anesthesiology. 2020;73(6):518-24.
28. Forozeshfard M, Jahan E, Amirsadat J, Ghorbani R. Incidence and factors contributing to low Back pain in the nonobstetrical patients operated under spinal anesthesia: a prospective 1-year follow-up study. Journal of PeriAnesthesia Nursing. 2020;35(1):34-7.
29. Meissner W, Huygen F, Neugebauer EA, Osterbrink J, Benhamou D, Betteridge N, et al. Management of acute pain in the postoperative setting: the importance of quality indicators. Current medical research and opinion. 2018;34(1):187-96.
30. Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC health services research. 2019;19(1):1-6.
31. Zeleke TG, Mersha AT, Endalew NS, Ferede YA. Prevalence and factors associated with back pain among patients undergoing spinal anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: an institutional based cross-sectional study. Advances in medicine. 2021;2021:1-8.
32. Borges NC, Costa B, Pedroso CF, Silva TC, Tatagiba BSF, Pereira LV. Dor pós-operatória em mulheres submetidas à cesariana. Enfermería Global. 2017;16(4):354-83.
33. Terfasa EA, Bulto GA, Irenso DY. Obstetric analgesia utilization in labor pain management and associated factors among obstetric care providers in the West Shewa Zone, Central Ethiopia. SAGE Open Medicine. 2022;10:20503121221088705.
34. Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database of Systematic Reviews. 2013(2).
35. Ramos-Rangel GE, Ferrer-Zaccaro LE, Mojica-Manrique VL, La Rotta MG. Management of post-cesarean delivery analgesia: Pharmacologic strategies. Colombian journal of anesthesiology. 2017;45(4):327-34.
36. Hussen I, Worku M, Geleta D, Mahamed AA, Abebe M, Molla W, et al. Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study. Annals of Medicine and Surgery. 2022;81:104321.
37. Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: What is new? Indian Journal of Anaesthesia. 2017;61(3):200.
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Sehrish Muzafar
Senior Registrar of Gynaecology and Obstetrics at Sahiwal Teaching Hospital, Sahiwal, Pakistan.
Rabia Shaukat
Demonstrator Pharmacology department at Sahiwal Teaching Hospital, Sahiwal, Pakistan.
Anam Yousaf
Senior Registrar of Gynaecology and Obstetrics at Sahiwal Teaching Hospital, Sahiwal, Pakistan.
Abeerah Zafar
Senior Registrar of Gynaecology and Obstetrics at Sahiwal Teaching Hospital, Sahiwal, Pakistan.
Shazia Naz
Demonstrator Biochemistry department at Sahiwal Teaching Hospital, Sahiwal, Pakistan.
Tayyaba Yasin
PhD student at The University of Campania Luigi Vanvitelli, Italy.
Hafsa Yaseen
Doctor of Physical Therapy at The University of Lahore, Pakistan.
Hina Allah Ditta
Additional Principal women medical officer at Sheikh Zayed Medical College Rahim Yar Khan, Pakistan.