Low back ache is one of the most common reasons for absenteeism as it causes frequent visits to the physician, both for backache and for the emotional component associated with the unresolving pain.
Spinal anaesthesia has been commonly linked to low back aches especially in patients who have had a caesarean section. There is a cloud of misconception and anxiety that forms a major cause for patients refusing a spinal anesthetic when it is an appropriate mode of anaesthesia. Interestingly, a search has revealed that general anesthetics carry a similar propensity to cause backaches.
Reasons for Back pain in Spinal anaesthesia
Analysing the reasons, there can be a number of mechanisms for the development of back pain in patients who have received an anesthetic via general or spinal anaesthetic route. It could be related to the surgery itself, the surgical position, the duration of surgery to name a few. Specifically for spinal anaesthetics, the potential reason could lie in the type of needle used, unintentional injection of saline or local anesthetic into the tissues, the development of a blood collection due to tissue trauma to the muscles and soft tissues and perhaps overstretching of the muscles after the desired relaxation has been achieved.
It is always tricky to diagnose and pinpoint a reason for the development of back ache. A lot of patients may have some degree of backache prior to the anesthetic for pregnancy or surgery. Whether the anesthetic technique can be a causal factor for the development of back pain or not is rather controversial and the jury is still out without a definite verdict.
Localized backaches after needle insertion usually resolves within a week, in rare situations, ominous and sinister causes of post spinal backache like spinal or epidural hematoma or an abscess needs to be ruled out through prompt investigation and subsequent treatment. In majority of cases, in the absence of any serious pathology conservative management like hot fomentation and simple painkillers like anti-inflammatories and paracetamol would suffice to control the symptoms.
Benefits of Spinal Anaesthesia
Spinal anaesthesia ensures prompt recovery, brings about early return of normal functions, reduces the chances of a blood clot following surgery and has less incidence of sickness and vomiting, when compared to a general anaesthetic for similar procedure. It is a very essential component of anaesthetic practices towards safer anaesthesia and should not be undermined as an option.
The evidence to link spinal anesthesia with subsequent chronic low back aches is not conclusive. There are many advantages of spinal anaesthesia over general anaesthesia from a risk benefit point for the patient. The acute pain that occurs after spinal injection usually resolves with simple measures.
Careful assessment, explanation, risk benefit discussion and reassurance preoperatively by the anaesthetist will go a long way in building trust and gaining the patients confidence.