Chia Yuan-Yi, Lo Yuan, Chen Yan-Bo, Liu Chun-Peng, Huang Wei-Chun, Wen Chun-Hsien
From the Department of Anesthesiology (Y-YC, YL, Y-BC, C-HW), Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Critical Care Center and Cardiovascular Medical Center (C-PL, W-CH), Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine (W-CH, C-PL), National Yang-Ming University, Taipei, Taiwan; and Department of Physical Therapy (W-CH), Fooyin University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2016 Apr;95(16):e3468. doi: 10.1097/MD.0000000000003468.
To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.
探讨接受剖宫产（CD）并采用神经轴索麻醉（NA）的产妇发生慢性腰痛（LBP）的风险。腰痛在孕期及产后均较为常见，但其病因尚不清楚。既往关于硬膜外分娩镇痛与慢性腰痛相关性的研究尚无定论。这些研究缺乏腰痛的客观诊断标准，且未排除可能的混杂因素。我们开展了这项基于全国人群的回顾性队列研究，以探究剖宫产并采用神经轴索麻醉与后续腰痛之间的关系。从台湾国民健康保险研究数据库（NHIRD）中，我们识别出了在2000年1月1日至2013年12月31日期间分娩的所有初产妇。利用国际疾病分类第九版临床修订本（ICD-9-CM）的手术编码，我们确定了经阴道分娩（VD）的女性和接受剖宫产的女性。麻醉方式通过国民健康保险编码确定。多变量逻辑回归用于估计接受剖宫产并采用神经轴索麻醉的女性与经阴道分娩的女性相比发生产后腰痛的几率。结局是根据首个ICD-9-CM诊断编码诊断为腰痛。对患者在产后观察3年，直至诊断为产后腰痛、退出国民健康保险系统、死亡或至2013年12月31日。在观察期内分娩的61027名初产妇中，40057名符合纳入本研究的条件。在这些女性中，27097名（67.6%）经阴道分娩，8662名（21.6%）接受脊髓麻醉的剖宫产，4298名（10.7%）接受硬膜外麻醉（EA）的剖宫产。发现接受硬膜外麻醉剖宫产的女性发生腰痛的风险高于经阴道分娩的女性，校正后的比值比为1.26（95%可信区间：1.17 - 1.34）。硬膜外麻醉剖宫产可能会增加后续慢性腰痛的风险。
