Local and Regional Anaesthesia
Background and Goal: Low back pain (LBP) is a common minor yet unpleasant complication after epidural anaesthesia. Different mechanisms are suggested such as needle trauma and myotoxicity of local anaesthetic. The aim of our study was to determine the incidence of low back pain depending on two different approaches of the epidural space: median and paramedian approach.
Material and Methods: 273 ambulatory patients ASA I-II, aged 20-73 years old undergoing lumbar epidural anaesthesia (levobupivacaine 0.5%) were assigned randomly to one of the two groups of the study. Group M (n = 142) in which epidural puncture was performed by median approach and group P (n = 131) in which epidural puncture was performed by paramedian approach (lateral position, L4/5 or L3/4 interspace). In both groups needle Tuohy 18 G was used. All patients were mobilised 6-7 hrs after operation. We recorded the number of epidural puncture attempts and the occurrence and duration of backache in the patients. All patients were followed up for 20 days. In the case of backache mild analgesics and NSAIDs were prescribed together with rest. Statistical analysis was achieved by using chisquare test and ANOVA-one way.
Results and Discussion: Both groups were comparable. The results are shown in the next table:
Conclusions: Taking into consideration the above results the paramedian approach of the epidural space seems to be associated with a lower incidence of low back pain.