Sehmbi Herman, D'Souza Rohan, Bhatia Anuj
Department of Anaesthesiology and Perioperative Medicine, University of Western Ontario, University Hospital, LHSC, London, ON, Canada.
Gynecol Obstet Invest. 2017;82(5):417-436. doi: 10.1159/000471764. Epub 2017 May 18.
Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP.
We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery.
In all, we included 78 studies in this review, with 32 studies concerning diagnostic investigations, 56 studies involving management strategies, and 4 studies regarding the use of neuraxial techniques for labour and delivery.
MRI is the safest investigative modality for LBP in pregnancy. Antenatal educational programmes, exercise and steroid injections into the epidural space or sacroiliac joints may help with pain management. Worsening neurological deficits, vertebral fractures and tumours may need surgical management. There is limited evidence on challenges of performing neuraxial blocks in the peripartum period for analgesia and anaesthesia, but there is a potential for increased risk of neurological complications in parturients with pre-existing neurological deficits.
下背痛（LBP）在孕期较为常见，且往往处理不当。在这些患者分娩期间使用神经轴索镇痛和麻醉的诊断检查、恰当处理及决策方面存在诸多不明确之处。本系统评价总结了有关LBP孕妇的检查、处理策略以及实施神经轴索阻滞的相关考虑因素的证据。
我们检索了3个数据库，并回顾了有关孕期LBP的诊断方式、处理策略以及用于促进分娩的神经轴索技术应用的文献。
本评价共纳入78项研究，其中32项研究涉及诊断检查，56项研究涉及处理策略，4项研究涉及神经轴索技术在分娩中的应用。
MRI是孕期LBP最安全的检查方式。产前教育计划、运动以及硬膜外腔或骶髂关节注射类固醇可能有助于疼痛管理。神经功能缺损加重、椎体骨折和肿瘤可能需要手术处理。关于围产期实施神经轴索阻滞用于镇痛和麻醉的挑战证据有限，但既往存在神经功能缺损的产妇发生神经并发症的风险可能增加。
