Kock S, Hopf H B
Abteilung für Anästhesie und Intensivmedizin Kreisklinik Langen.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1998 Oct;33(10):648-52. doi: 10.1055/s-2007-994826.
To determine the incidence of long term backache after lumbar epidural anesthesia with catheter (EPA) in the non-obstetrical setting.
Prospective 1-year follow-up study.
All patients scheduled for elective arthroscopical surgery of the knee performed under EPA (n = 195).
A first questionnaire was sent to each patient three months after the operation. To chose patients reporting persistent backache after three months, a second questionnaire was sent one year after the operation.
Back pain before, within 5 days and at the time of the inquiry, i.e., three months and one year after EPA as well as patient satisfaction with the regional anesthetic. Statistic: contingency tables with Fisher's exact test (for categorical variables) and an unpaired t-Test (for continuous variables), p < 0.01 after adjustment for multiple testing (Bonferroni's method).
Response rate was 67%. Before EPA 23 patients (17.5%) complained of back pain. The short term incidence of back pain (i.e, within 5 days after EPA) was 24 out of 131 patients (18.3%) and not associated with pre-epidural back pain (p = 0.036, n.s.). 15 out of 131 patients (11.5%) reported persistent back pain after three months, 13 of them had complained of back pain before EPA (p < 0.0001). Thus, the incidence of new back pain 3 months after EPA was only 1.5%. 7 of the 15 patients returned the second questionnaire: 6 reported still persistent back pain, and all had complained of back pain before EPA. Age, height, weight, sex, duration of anesthesia and operation were not associated with long term back pain. Despite persistent back pain after three months 10 out of 15 patients would opt again for EPA.
The incidence of long term backache after EPA in the non-obstetrical setting is 11.5% and almost exclusively associated with pre-existing back pain. Biometrical factors seem to play no role. In patients with pre-existing back pain satisfaction with the anesthetic procedure might be improved by improving informed consent.
确定非产科环境下留置导管腰椎硬膜外麻醉（EPA）后长期背痛的发生率。
前瞻性1年随访研究。
所有计划在EPA下进行择期膝关节镜手术的患者（n = 195）。
术后3个月向每位患者发送第一份问卷。为挑选出术后3个月仍有持续性背痛的患者，术后1年发送第二份问卷。
EPA前、术后5天内以及调查时（即EPA后3个月和1年）的背痛情况，以及患者对区域麻醉的满意度。统计学方法：采用Fisher精确检验的列联表（用于分类变量）和非配对t检验（用于连续变量），经多重检验校正（Bonferroni法）后p < 0.01。
回复率为67%。EPA前23例患者（17.5%）主诉背痛。背痛的短期发生率（即EPA后5天内）为131例患者中的24例（18.3%），且与硬膜外麻醉前背痛无关（p = 0.036，无统计学意义）。131例患者中有15例（11.5%）报告术后3个月仍有持续性背痛，其中13例在EPA前曾主诉背痛（p < 0.0001）。因此，EPA后3个月新发背痛的发生率仅为1.5%。15例患者中有7例返回了第二份问卷：6例报告仍有持续性背痛，且均在EPA前曾主诉背痛。年龄、身高、体重、性别、麻醉和手术持续时间与长期背痛无关。尽管术后3个月仍有持续性背痛，但15例患者中有10例仍会再次选择EPA。
非产科环境下EPA后长期背痛的发生率为11.5%，几乎完全与既往存在的背痛相关。生物统计学因素似乎不起作用。对于既往有背痛的患者，通过改善知情同意可能会提高对麻醉程序的满意度。
