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[Back pain after epidural anesthesia].

S Le Borgne1, A Muller, P Wasser

  • 1Département d'Anesthésiologie, Centre Hospitalier Régional et Universitaire, Strasbourg.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1991
PubMed
Summary
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A patient experienced severe back pain after epidural anesthesia due to a vagal reaction and headfall. This posterior articular joint syndrome resolved with conservative treatment, suggesting caution with epidural anesthesia in patients with prior back pain.

Area of Science:

  • Anesthesiology
  • Orthopedics
  • Neurology

Background:

  • A 24-year-old female with a history of lumbar backache underwent an orthopaedic procedure.
  • Epidural anesthesia was administered with the patient in a sitting position.

Observation:

  • The patient experienced an acute vagal reaction, including loss of consciousness and forward headfall during the procedure.
  • Post-procedure, she developed severe, widespread vertebral column pain, sciatica, and paravertebral muscle contraction unresponsive to medication.

Findings:

  • Epidural abscess or hematoma were excluded as causes of the pain.
  • The patient's symptoms resolved within days with conservative management, including a cervical collar, anti-inflammatory drugs, and spinal manipulation.
  • The back pain was likely attributed to a posterior articular joint syndrome exacerbated by the forward headfall.

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Implications:

  • This case highlights a potential complication of epidural anesthesia, particularly in patients with pre-existing spinal issues.
  • Forward headfall during anesthesia administration may contribute to or precipitate spinal pain syndromes.
  • Careful patient selection and consideration of alternative anesthesia techniques are recommended for individuals with a history of back pain.