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Back pain: the dangers of surgery

MagazineDecember 1993 (Vol. 4 Issue 9)Back pain: the dangers of surgery

Epidural anaesthesia for pain relief during childbirth and for outpatient 'awake' surgery has been found to cause a high incidence of long-term back pain

Epidural anaesthesia for pain relief during childbirth and for outpatient 'awake' surgery has been found to cause a high incidence of long-term back pain.

A groundbreaking study by the UK's University of Birmingham Medical School (BMJ, 7 July, 1990) showed that nearly a fifth (18 per cent) of women with epidural anaesthesia during labour reported long-term backache - twice the number who report backache after labour. The report concluded that of every hundred women who have an epidural during labour, eight will `develop long-term backache as a direct consequence.'

The findings of the Birmingham study were backed by a more recent study (BMJ, 15 May 1993) and a study done by the National Childbirth Trust (Some Women's Experiences of Epidurals, a descriptive study, The National Childbirth Trust, 1987).

The NCT study and the published medical studies suggest that the problem is a postural one - women can remain in a potentially damaging position, often for some hours, without knowing it. Nevertheless, people given epidurals for other reasons, including pain relief, also suffer backache. In a study of 9000 patients given epidurals for surgery other than childbirth, one in 50 complained of backache afterward. Pauline was given an epidural during a ` routine bladder operation:' After a series of subsequent operations to relieve the problems caused by the first, she was left in incapacitating pain - a situation later diagnosed as LSAA.

This isn't surprising considering the postmortem findings of 10 patients who'd had postoperative epidurals (Anaesthesia, 1990; 45: 357-61). All 10 had evidence of 'non-specific epidural inflammatory reactions', and seven patients showed signs of epidural infection - a recipe for spinal trauma. No similar pathology was found in a control group which did not have epidural catheters. Other studies show that a fifth of those getting epidurals have `contamination' (Anesthesia and Analgesia, 1977; 56: 222-5).

Dr Christine MacArthur, the senior research fellow who conducted the Birmingham study, says there is virtually no investigation of the long-term problems associated with spinal anaesthesia. One study (JAMA, 161: 586-91) showed long-term back problems with spinal anaesthetic (in which the anaesthetic is injected right through the spinal membranes), but that was in 1956, and no one has really looked at it since.

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