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Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery
With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort
Study
#MMPMID27100449
Chia YY
; Lo Y
; Chen YB
; Liu CP
; Huang WC
; Wen CH
Medicine (Baltimore)
2016[Apr]; 95
(16
): e3468
PMID27100449
show ga
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.
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