Macarthur A J, Macarthur C, Weeks S K
Department of Anesthesia, University of Calgary, Alberta, Canada.
Anesth Analg. 1997 Nov;85(5):1066-70. doi: 10.1097/00000539-199711000-00019.
The association between epidural anesthesia during labor and subsequent postpartum low back pain remains unclear. The objective of this follow-up cohort study was to determine whether epidural anesthesia was associated with chronic back pain 1 yr after delivery. We contacted 329 women by telephone and asked them to complete a standardized questionnaire 1 yr (+/-1 mo) after delivery. One hundred sixty-four women had received epidural analgesia for labor and delivery, and 165 had not. Subjects were asked to quantify their back pain (yes/no, numeric rating score, and interference with daily activities). Differences between the two groups were tested by using the chi2 test and the Mann-Whitney U-test, and logistic regression was used to control for confounding variables. The response rate was 244 of 329 (74%). Responders and nonresponders were similar in their demographic and clinical characteristics. There was no difference in the prevalence of back pain between women who had received epidural anesthesia (12 of 121, 10%) and those who had not (17 of 123, 14%). The adjusted relative risk of low back pain at 1 yr (epidural versus nonepidural) was 0.63 (95% confidence interval 0.25, 1.56). There were also no differences between the two groups on numeric rating scores or level of interference with activities. This prospective follow-up study demonstrated no association between epidural anesthesia for labor and delivery and chronic back pain 1 yr after delivery.
We evaluated the presence of low back pain 1 yr after delivery in two groups of women-those who chose epidural analgesia for labor and those who did not. There was no increased risk of back pain in women who had used epidural analgesia. This finding is consistent with those of other North American studies.
分娩期间硬膜外麻醉与产后腰痛之间的关联仍不明确。这项随访队列研究的目的是确定硬膜外麻醉是否与分娩后1年的慢性背痛有关。我们通过电话联系了329名女性，要求她们在分娩后1年（±1个月）完成一份标准化问卷。164名女性在分娩时接受了硬膜外镇痛，165名女性未接受。受试者被要求对她们的背痛进行量化（是/否、数字评分量表以及对日常活动的干扰程度）。两组之间的差异采用卡方检验和曼-惠特尼U检验进行检验，并使用逻辑回归来控制混杂变量。回复率为329人中的244人（74%）。回复者和未回复者在人口统计学和临床特征方面相似。接受硬膜外麻醉的女性（121人中的12人，10%）和未接受硬膜外麻醉的女性（123人中的17人，14%）之间背痛的患病率没有差异。1年时腰痛的调整相对风险（硬膜外麻醉组与未麻醉组）为0.63（95%置信区间0.25，1.56）。两组在数字评分量表或活动干扰程度方面也没有差异。这项前瞻性随访研究表明，分娩时的硬膜外麻醉与分娩后1年的慢性背痛之间没有关联。
我们评估了两组女性分娩后1年的腰痛情况，一组是选择硬膜外镇痛分娩的女性，另一组是未选择的女性。使用硬膜外镇痛的女性背痛风险没有增加。这一发现与其他北美研究的结果一致。
