Neuraxial block and pregnancy-related low back pain

Abstract

Background Pregnancy-related low back pain(PLBP) is a common pathological condition during pregnancy and postpartum. Neuraxial block is the most useful technology for analgesia during cesarean section and labor, and the causal link between neuraxial block and PLBP has been a hot topic in obstetrics research. Objective To review the research progress in the relationship between neuraxial block and PLBP. Content PLBP includes pregnancy-related lumbar pain(PLP) and pelvic girdle pain(PPGP). PLP is triggered by specific movement or posture, and usually radiates from low back to feet, while PPGP may reduce endurance in sitting, standing, and walking. In comparison with general anesthesia, neuraxial block raises incidence of PLBP because it involves tissue damages, hemorrhage, relaxation of skeletal muscles, and stretch of tendons. Tissue damage and hemorrhage during neuraxial block can be reduced by ultrasound-assisted guidance. Cautions should be taken to relieve low back pain during pregnancy with neuraxial block because of risk of failure and complications. Ultrasound-guided neuraxial block can be used for analgesia during natural labor and cesarean section. Evidence is inconsistent to support whether neuraxial block during pregnancy and delivery is a risk factor of PLBP. Trend The current evidence seems do not support that labor analgesia with neuraxial block increase the incidence of PLBP. Future studies are demanded to clarify the relationship between epidural anesthesia and short/long-term PLBP. Key words: Neuraxial block; Pregnancy-related low back pain