According to the American Society of Regional Anesthesia and Pain Medicine, anesthesiologists currently use epidural anesthesia, either alone or in conjunction with other methods, to provide intra- and post-operative pain control for a variety of gastrointestinal, gynecologic, urologic, obstetric, orthopedic and vascular procedures. In order to obtain epidural anesthesia, an anesthesiologist advances a long, fine needle into the space between the ligaments of the back bone and the outer covering of the cord itself. Back pain after the procedure is a common complaint.
Cause
Back pain from an epidural usually results from local inflammation of the skin and tissue through which the needle was inserted. Reflex muscle spasms sometimes accompany inflammation, producing episodic, crampy pain, in addition to dull, aching pain.
Incidence
According to anesthesiologist Wayne Kleinman, between 25 and 30 percent of patients complain of back pain from an epidural. However, Kleinman notes, this figure is not significantly different from the percentage of patients who complain of back pain after general anesthesia, which does not involve inserting a needle into the back, or the incidence of back pain in the population at-large.
Time Frame
Back pain from epidural anesthesia usually begins when anesthetic drugs start to wear off---about two to six hours after they are discontinued, according to the American Society of Regional Anesthesia and Pain Medicine. Pain may last anywhere from a few days to, in rare cases, a number of weeks.
Location
Back pain from an epidural should localize around the needle insertion site. This is usually the lower part of the back bone, known as the lumbar spine. If an anesthesiologist accidentally advances the needle past the dural membrane, she will warn the patient about a complication known as post-dural puncture headache. In that case, patients may experience head ache and back pain that seems to radiate down the neck from the head, in addition to pain at the needle insertion site.
Management
In most cases, back pain from an epidural responds to over-the-counter acetaminophen or non-steroidal anti-inflammatory medications. All post-operative patients should obtain a recommendation from their surgeon before self-medicating. Non-medicinal remedies that seem to help include use of alternating warm and cold compresses and limiting activities that could potentially strain the back, such as lifting heavy objects.
Emergency Warning Signs
In rare cases, back pain signals the presence of infection or injury to the spinal cord. Patients who experience severe pain, pain that seems to get worse over the course of a few days and pain that is accompanied by numbness, muscle weakness, loss of bowel or bladder control, fever or insertion site redness should contact their doctors for advice, or proceed to the nearest emergency room.
References
- "Clinical Anesthiology, 4th edition;" G.E. Morgan et al.; 2006
- American Society of Regional Anesthesia and Pain Medicine: Patient Information
- MedlinePlus: Spinal and Epidural Anesthesia
