Overview
of the Incidence of Post-Sectio Caesaria Back Pain with Spinal Anesthesia: A Literature Review
Tinjauan Kejadian Nyeri Punggung Post-Sectio Caesaria dengan Anestesi
Tulang Belakang: Tinjauan Literatur
1)* Agung Manik
Septiana Putra, 2) I Made Gede Widnyana
12 Prima Medika General Hospital,
Bali, Indonesia
Email: [email protected]���������
*Correspondence: Agung Manik Septiana
Putra
DOI: 10.59141/comserva.v4i6.2551 |
ABSTRACT Post-cesarean back pain with spinal anesthesia is
one of the most common complications and can affect the patient's quality of
life. Although spinal anesthesia is a safe and commonly used option in
surgical procedures, the risk of back pain remains, especially if the
anesthesia technique is not optimal. This study aims to provide an overview
of the incidence of post-cesarean section back pain with spinal anesthesia
based on a literature review over the past 10 years. This study is a
literature review that reviews 10 scientific journals published in the last
10 years. The focus of this study includes the prevalence of back pain, risk
factors, anesthesia techniques, and post-cesarean section back pain
management. The results of the review showed that the prevalence of
post-cesarean back pain ranged from 30% to 50%, with the main risk factors
being age, body mass index, and anesthesia techniques. The use of smaller
atraumatic needles and careful anesthesia techniques can reduce the incidence
of back pain. Back pain is generally temporary, but in some patients it can develop into chronic pain. Post-cesarean
section back pain with spinal anesthesia can be prevented with proper
anesthesia techniques and good pain management. A multidisciplinary approach
is needed to reduce the prevalence of chronic pain and improve the patient's
quality of life. Keywords: Incidence of back pain, sectio caesarea, spinal anesthesia |
|
ABSTRAK Nyeri punggung pasca caesar setelah anestesi tulang belakang adalah komplikasi umum yang dapat memengaruhi kualitas hidup pasien. Meskipun anestesi tulang belakang adalah pilihan yang aman dan umum digunakan dalam prosedur bedah, risiko nyeri punggung tetap ada, terutama jika teknik anestesi
tidak optimal. Penelitian ini
bertujuan untuk memberikan gambaran umum tentang kejadian nyeri punggung
pasca caesar dengan anestesi tulang belakang berdasarkan tinjauan literatur
dari 10 tahun terakhir. Ini adalah tinjauan pustaka yang mengkaji 10 jurnal
ilmiah yang diterbitkan dalam 10 tahun terakhir. Fokus tinjauan meliputi
prevalensi nyeri punggung, faktor risiko, teknik anestesi, dan manajemen
nyeri punggung pasca-caesar. Tinjauan ini menunjukkan bahwa prevalensi nyeri
punggung pasca-caesar berkisar antara 30% hingga 50%, dengan faktor risiko
utama termasuk usia, indeks massa tubuh, dan teknik anestesi. Penggunaan
jarum atraumatik yang lebih kecil dan teknik anestesi yang cermat dapat
mengurangi kejadian nyeri punggung. Sementara sebagian besar nyeri punggung
bersifat sementara, beberapa pasien mungkin mengalami nyeri kronis. Nyeri
punggung pasca-caesar dengan anestesi tulang belakang dapat dicegah dengan
teknik anestesi yang tepat dan manajemen nyeri yang efektif. Pendekatan
multidisiplin diperlukan untuk mengurangi prevalensi nyeri kronis dan
meningkatkan kualitas hidup pasien. Kata kunci: Kejadian sakit punggung, sectio caesarea, anestesi tulang belakang |
INTRODUCTION
Post-operative
back pain is a frequent complaint in patients undergoing sectio
caesarean section (SC), particularly when spinal anesthesia
techniques are used (Lavand'homme, 2017). Spinal anesthesia is preferred in many SC procedures because it
provides a fast and stable sensory block, reducing the risk of general anesthesia complications (Hampl et al., 2019). However,
despite its advantages, spinal anesthesia is also
associated with several side effects, including back pain (Lavand'homme,
2017). The complaints of back pain often arise in the post-operative period,
with severity ranging from mild to moderate (Ding et al., 2020).
Various
studies have examined the incidence of back pain after SC with spinal anesthesia, although the reported prevalence varies. One
study indicated that 30-50% of women undergoing SC reported back pain within
the first 24-48 hours post-surgery (Qin et al., 2018). Another study found a
similar prevalence, with approximately 40% of patients experiencing
post-operative back pain (Rahman et al., 2021). The duration of pain varies,
with most complaints subsiding within a few days to a few weeks post-surgery, although
chronic back pain can persist in some cases and affect patients' quality of
life (Bharti et al., 2018).
Risk
factors contributing to the onset of post-SC back pain with spinal anesthesia include age, body mass index (BMI), parity, and
the technique and type of needle used in the procedure (Touray et al., 2015).
Higher BMI has been associated with an increased risk of back pain, with obese
patients experiencing more frequent and severe pain than those with normal BMI
(Etezadi et al., 2020). Additionally, the technical
aspects of the anesthesia procedure, such as the type
of needle, also play a significant role in the development of post-operative
pain. Studies have shown that the use of atraumatic (non-cutting) needles
significantly reduces the incidence of post-operative back pain due to reduced
tissue trauma and lower risk of cerebrospinal fluid leakage (Cavallaro et al.,
2014; Ture et al., 2019).
Conversely,
improper technique or the use of larger needles increases the risk of local
tissue injury, leading to back pain (Gupta et al., 2017). One study found that
patients who received spinal anesthesia with
larger-gauge needles reported significantly higher rates of post-operative back
pain compared to those who received finer needles (Singh et al., 2016). This
suggests that careful selection of needle type and size is critical in
minimizing back pain risks.
Management
of post-SC back pain is essential, even if the pain is temporary. If left
unmanaged, the pain may develop into chronic conditions, significantly
impacting the patient's daily activities (Lavand'homme
& Eisenach, 2015). Early intervention with analgesics and physical therapy
has been shown to reduce the progression of acute to chronic pain in
post-operative cases (Lam et al., 2019). Furthermore, individualized pain
management protocols that consider patient-specific factors, such as BMI and
previous pain experiences, may enhance treatment outcomes (Benedetti et al.,
2018).
Conclusion:
While post-SC back pain with spinal anesthesia is
generally transient, appropriate pain management is necessary to prevent the
development of chronic pain. This review seeks to provide a comprehensive
understanding of the prevalence, risk factors, and management strategies for
back pain following spinal anesthesia in SC, drawing
from studies conducted over the last 10 years (Milan et al., 2021). By
addressing both patient-related and procedural factors, healthcare providers
can reduce the incidence and severity of post-SC back pain and improve patient
outcomes (Jones et al., 2020).
RESEARCH
METHODS
This
study is a systematic literature review that examines various studies that have
been published in the last 10 years related to the incidence of post-sectio caesarean back pain with spinal anesthesia.
The sources of literature used are taken from several scientific databases such
as PubMed, Google Scholar, and ScienceDirect. The search was conducted using
the keywords "back pain", "sectio caesaria", "spinal anesthesia",
and "post-sectio complications". Only
articles published in the time span between 2014 and 2024 are considered in
this review.
The
inclusion criteria used in this study included studies that explicitly reported
the incidence of back pain after sectio caesarean
section with spinal anesthesia. Articles that
included the female population of reproductive age (18-45 years) and reports on
risk factors, duration, and severity of back pain were also included.
Meanwhile, studies involving general anesthesia,
surgical procedures other than sectio caesaria, or reports of back pain unrelated to spinal anesthesia were excluded from this analysis.
The
article selection process is carried out in several stages. First, the results
of the literature search are filtered based on title and abstract. Articles
that meet the inclusion criteria are then reviewed in full. The data extracted
from each article included the number of study subjects, the prevalence of back
pain, the risk factors identified, the anesthesia
techniques used, as well as the post-operative pain management methods. Once
all the data were collected, the results of the studies were compared to look
for general patterns and differences in the results of the studies.
Data
analysis was carried out using a descriptive method. The results of each
article are then categorized based on key themes, such as the prevalence of
back pain, risk factors, and treatment methods. A comparison of the results of
the various studies was conducted to provide a more thorough picture of the
incidence of post-sectio caesarean back pain with
spinal anesthesia. The limitations of each study were
also noted to consider the potential for bias that could affect the results of
the study.
RESULTS AND DISCUSSION
Table 1.
Literature Review
No. |
Writer |
Heading |
Journal |
Year |
Research Methods |
Research Results |
1 |
Lavand'homme |
Postoperative Pain After Cesarean Delivery |
Anesthesiology |
2017 |
Systematic review |
The prevalence of post-sectio back pain is
30-50%. Pain is generally mild to moderate, rarely chronic. |
2 |
Qin et
al. |
Long-Term
Post-Spinal Headache and Backache after Cesarean
Section |
European
Journal of Anesthesiology |
2018 |
Prospective
study in 500 patients |
15% of
patients experience back pain for more than one week. The risk is increased
in patients with high BMI. |
3 |
Touray et al. |
Incidence and Risk Factors of Postdural
Puncture Headache and Back Pain |
International Journal of Obstetric Anesthesia |
2015 |
Retrospective studies |
Age, BMI, and anesthesia techniques affect
the incidence of back pain. Large needles increase the risk. |
4 |
Cavallaro
et al. |
Spinal
Anesthesia and Postoperative Back Pain in Cesarean Deliveries |
Journal
of Pain Research |
2014 |
Observational
studies |
Women
with obesity are more prone to post-cesarean back
pain. |
5 |
Apfelbaum et al. |
Chronic Pain Following Cesarean Section |
Pain Management Journal |
2017 |
Cohort studies |
5% of patients develop chronic pain that lasts more than 6 months. |
6 |
Mohamed
et al. |
Prevention
of Post-Spinal Back Pain Using Smaller Gauge Needles |
Journal
of Anesthesia |
2016 |
RCT (Randomized
Controlled Trial) |
Atraumatic
needling reduces the incidence of back pain. |
7 |
Wang et al. |
Analysis of Spinal Anesthesia-Related
Complications in Cesarean Section |
BMC Anesthesiology |
2020 |
Cohort studies |
CSF leakage is related to back pain. The use of atraumatic techniques
lowers the risk. |
8 |
Smith
et al. |
The
Role of BMI in Postoperative Pain Outcomes after Cesarean
Delivery |
Obstetric
Anesthesia Digest |
2019 |
Studi
cross-sectional |
A high
BMI is associated with more severe back pain. |
9 |
Johnson et al. |
Post-Cesarean Pain and its Impact on Early
Recovery |
Journal of Clinical Anesthesia |
2015 |
Prospective clinical studies |
Back pain affects the patient's mobilization and recovery in the first
48 hours. |
10 |
Ahmed
et al. |
Comparative
Study of Post-Spinal and General Anesthesia-Related
Back Pain |
International
Journal of Anesthesiology |
2021 |
Comparative
studies |
Back
pain is more common in patients undergoing spinal anesthesia
than general anesthesia. |
1. Prevalence of Post-Sectio Caesaria Back Pain
Back pain is one of the common complaints
experienced by patients after undergoing sectio
caesarean section with spinal anesthesia. Some
studies have mentioned that the prevalence of post-sectio
back pain incidence ranges from 30% to 50% (Lavand'homme,
2017; Qin et al., 2018). These complaints usually occur within the first 24-48
hours after surgery and are temporary. Most patients report mild to moderate
pain that can be treated with the use of simple analgesics, such as paracetamol
or nonsteroidal anti-inflammatory drugs (NSAIDs).
However, there have also been reports of cases
where back pain lasts longer than expected. A retrospective study by Qin et al.
(2018) showed that about 15% of patients experienced back pain that lasted up
to more than one-week post-sectio. This is often
associated with technical factors during the anesthesia
procedure, such as the size of the needle used, the volume of the anesthesia, or the injection technique.
Other studies have found that the incidence of
post-sectio back pain can also last longer in
patients with a previous history of back pain or musculoskeletal complaints
during pregnancy. For example, Lavand'homme (2017)
reported that patients who experienced back pain during the third trimester of
pregnancy had a higher likelihood of experiencing post-operative back pain. In
addition, the risk of back pain events also appears to be increased in patients
with a higher body mass index (BMI).
Although the prevalence of back pain varies between
studies, one thing is clear: it can affect a patient's quality of life after
the surgical procedure. Therefore, it is important to understand how often and
how long this pain occurs in order to design an effective management strategy.
Furthermore, future research needs to explore why some patients experience
long-term pain, while others experience only temporary pain.
The overall literature suggests that although the
prevalence of post-sectio caesarean back pain is
relatively high, most patients do not need more invasive interventions other
than basic medical therapy. Improved anesthesia
techniques as well as a more personalized approach to postoperative management
can play a role in reducing the incidence of long-term pain.
2. Risk Factors Affecting the Incidence of Back Pain
Various risk factors have been identified as
potential contributors to the incidence of post-sectio
caesarean back pain with spinal anesthesia. Research
by Touray et al. (2015) shows that the age factor is one of the important
variables. Older patients tend to have a higher risk of developing back pain
than younger patients. This may be due to decreased tissue elasticity and
regenerative capacity in older patients, which can prolong recovery time.
Another factor that is often associated is body
mass index (BMI). A study by Cavallaro et al. (2014) showed that women with
higher BMI tended to experience more severe post-operative back pain compared
to those with normal BMI. This is likely due to extra pressure on the spine and
joints, as well as greater technical difficulties during the anesthesia procedure in obese patients. Therefore, BMI
should be considered as an important risk factor in determining the risk of
post-cesarean back pain.
Parity or the number of previous pregnancies was
also found to be associated with the risk of back pain. Women who have had more
than one pregnancy are reported to have a higher likelihood of experiencing
back pain (Apfelbaum et al., 2017). It may be related to structural changes in
the body during some pregnancies, such as stretching muscles and ligaments, as
well as biomechanical changes in the spine that can increase susceptibility to
post-operative pain.
In addition to physiological and technical factors,
psychosocial aspects such as anxiety levels also play an important role in the
incidence of back pain. Patients who had higher levels of anxiety or stress
before surgery tended to report more severe post-operative pain (Lavand'homme, 2017). This factor demonstrates the
importance of a multidisciplinary approach to post-sectio
pain management, which involves handling the psychological and physical aspects
of the patient.
Overall, research shows that the incidence of post-cesarean back pain is influenced by a variety of risk
factors, both related to patient characteristics and technical aspects of the anesthesia procedure. Therefore, pain management strategies
must be tailored to individual risk factors to ensure optimal outcomes.
3. Duration and Severity of Pain
The duration and severity of post-sectio caesarean back pain varies greatly between patients.
In most cases, back pain appears within a few hours of surgery and lasts for
several days. Lavand'homme (2017) reported that 75%
of patients experienced a decrease in pain within 48 hours after surgery.
However, in a small percentage of patients, back pain can last longer, with
some reporting pain lasting up to several weeks.
The severity of the pain also varies from mild to
moderate. A study by Qin et al. (2018) found that most patients reported pain
on a scale of 2-4 out of 10 on the visual analogue scale (VAS). This pain can
generally be treated with simple analgesics such as paracetamol or ibuprofen.
However, in some more severe cases, patients may require more robust
pharmacological interventions, including mild opioids or physical therapy.
In rarer cases, post-sectio
back pain can become chronic. Apfelbaum et al. (2017) noted that about 5% of
patients develop chronic back pain that lasts more than 6 months after surgery.
This chronic pain is usually more difficult to treat and can affect the
patient's daily activities as well as quality of life. Factors such as a
previous history of chronic pain and anesthesia
techniques used during a cesarean section are often
associated with the occurrence of this chronic pain.
The duration and severity of pain is also greatly
influenced by the anesthesia technique used during
surgery. The use of smaller atraumatic needles may help reduce tissue trauma
and the risk of long-term back pain (Cavallaro et al., 2014). In addition, the
volume and type of anesthetic medication administered
also play a role in determining the severity of post-operative pain. Proper use
of spinal anesthesia can reduce the risk of
complications such as cerebrospinal fluid leakage that contributes to back pain.
Overall, the duration and severity of post-sectio back pain varies greatly depending on the individual
characteristics of the patient and the anesthesia
technique used. Most cases can be managed with proper pain management, but
there is a need for a more proactive approach in preventing chronic pain.
4. Effects of Spinal Anesthesia
on the Mechanism of Back Pain
Spinal anesthesia works
by blocking the transmission of sensory nerves in the lower back and lower
extremities region through the injection of anesthesia
into the cerebrospinal fluid. Although these techniques are generally safe and
effective, some mechanisms can cause post-procedure back pain. One of the main
causes is irritation of the nerves or soft tissues that occurs during the
injection of anesthesia (Touray et al., 2015). The
needles used in spinal anesthesia can cause minor
trauma to local tissues, which can cause pain.
Cerebrospinal fluid leakage (CSF) is another
complication often associated with back pain. When a CSF leak occurs, the
pressure inside the spine can decrease, causing pain in the lower back and
surrounding area (Apfelbaum et al., 2017). This leakage usually occurs when the
needle used for the spinal procedure is too large or the injection technique is
improper. The use of atraumatic needles has been shown to reduce the risk of
CSF leakage, and therefore, also reduce the incidence of post-procedural back
pain.
Research by Qin et al. (2018) found that more
invasive anesthesia techniques, such as the use of
larger spinal needles, were associated with a higher incidence of back pain.
The use of larger needles can increase the risk of injury to local tissues, as
well as increase the risk of CSF leakage. Therefore, there is a strong
recommendation to use smaller needles and more careful techniques to reduce the
risk of post-cesarean back pain.
In addition, the volume and type of anesthetic medication used also affect the incidence of
back pain. Excessive volume of anesthesia can cause
distension in the lower back structures, which ultimately triggers pain.
Therefore, the dose of anesthesia should be adjusted
to the patient's weight and other relevant factors to minimize the risk of side
effects.
Overall, although spinal anesthesia
offers many advantages, such as a rapid onset and a reduced risk of general
complications, the risk of post-operative back pain remains. Therefore,
attention should be paid to the technical aspects of the anesthesia
procedure to reduce potential complications.
5. Post-Sectio Caesaria Back Pain Management
Management of post-cesarean
section back pain is essential to speed up recovery and improve patients'
quality of life. The first step in pain management is the use of simple
analgesic drugs such as paracetamol and NSAIDs. Most studies report that mild
to moderate back pain can be successfully managed with these medications (Lavand'homme, 2017). Regular administration of medication
during the first 48 hours post-surgery is usually enough to reduce pain.
For more severe cases of pain, the use of mild
opioids, such as tramadol, may be an option. However, its use should be
cautious due to the risk of side effects such as sedation and dependence. In
addition to pharmacotherapy, non-pharmacological approaches are also gaining
more attention. Physical therapy and relaxation techniques such as massage or
acupuncture can help reduce muscle tension and speed up recovery (Qin et al.,
2018).
The use of smaller atraumatic needles and careful anesthesia techniques are also important steps in
preventing post-cesarean back pain. A study by
Cavallaro et al. (2014) showed that the incidence of back pain can be
significantly reduced with the use of smaller needles and proper management of anesthesia.
Chronic pain management requires a more
comprehensive approach, especially in patients who experience back pain for
more than a few weeks. In these cases, the use of intensive physical therapy
and psychological counseling may be necessary to
address the physical and emotional components of pain (Lavand'homme,
2017).
Overall, the management of post-sectio
caesarean back pain requires a multidisciplinary approach involving a
combination of pharmacological and non-pharmacological therapies. Optimization
of anesthesia techniques and pain management
immediately after surgery is key to reducing the incidence of long-term pain
and improving the patient's quality of life.
Discussion
1. Prevalence of Back Pain After Sectio Caesaria
Post-sectio caesarean back pain is a common complication that
patients often experience after a cesarean section
with spinal anesthesia. Some studies suggest the
prevalence of these events ranges from 30% to 50%, depending on various
factors, including the anesthesia method used and the
patient's characteristics (Lavand'homme, 2017).
Although this prevalence is quite high, most cases involve only mild to
moderate levels of back pain, which can usually be managed with simple
treatment.
Post-sectio back pain usually occurs within the first 48 hours
after surgery. However, some patients report pain symptoms that last longer,
even up to a few weeks after surgery. In some cases, this pain can develop into
a chronic condition that requires further treatment. Although most patients
recover quickly, the risk of persistent or worsening pain should be considered
in treatment planning.
Research
by Lavand'homme (2017) shows that technical factors
in spinal anesthesia greatly affect the prevalence of
pain. Less than optimal techniques, such as the use of larger needles or
careless injection procedures, can increase the risk of trauma to the tissues
and structures of the back, ultimately increasing the likelihood of post-operative
pain. Therefore, attention to good anesthesia
techniques is essential in lowering the prevalence of back pain after surgery.
Overall,
although post-sectio caesarian
back pain is common, many factors affect its severity. Good management in terms
of anesthesia techniques and post-operative care can
help reduce the prevalence and impact of this pain on patients, ensuring faster
recovery and a better quality of life after surgery.
2.
Risk
Factors Affecting Back Pain
Risk
factors that affect the occurrence of post-cesarean
section back pain include age, body mass index (BMI), parity, and previous
history of back pain. Older age is often associated with an increased risk of
back pain, due to degenerative changes in the spine and muscles that are more
susceptible to injury during or after the surgical procedure (Touray et al.,
2015). In addition, a higher BMI also plays a major risk factor, as being
overweight puts additional pressure on the spine and surrounding tissues.
Patients
with a history of back pain or musculoskeletal pain during pregnancy are also
more likely to experience post-operative back pain. This is due to
biomechanical changes during pregnancy that put extra pressure on the lower
back. In addition, pregnancy hormones such as relaxin
can cause a weakening of the ligament structures that support the spine, making
it susceptible to injury during spinal anesthesia
procedures.
Parity,
or the number of pregnancies a woman experiences, also affects the risk of back
pain. Patients with more previous pregnancies tend to have a higher risk of
developing pain complications. This may be caused by the accumulation of
biomechanical stress on the back that occurs during several pregnancies and
childbirth. Therefore, parity needs to be considered in the risk management of
patients who will undergo sectio caesarean section.
Research
also shows that lifestyle factors, such as lack of physical activity and poor
posture habits, can worsen the risk of post-operative back pain. Therefore, a
thorough assessment of each patient's individual risk factors is essential in
determining the appropriate treatment approach to minimize the risk of post-cesarean back pain.
3. Duration and Severity of Pain
The
duration and severity of post-sectio caesarean back
pain varies between patients, depending on several factors, including the anesthesia technique, the patient's health condition, and
the individual's level of sensitivity to pain. Most patients report that back
pain is temporary and usually subsides within the first 48 to 72 hours after
surgery. In these cases, mild to moderate pain can be managed with simple
analgesic medications such as paracetamol or NSAIDs.
However,
in a small percentage of patients, back pain can last longer and become more
severe. Pain that persists for a few weeks to months can develop into chronic
pain, which requires more complex treatment. This chronic pain incidence is
more common in patients with a previous history of back pain or those who have
experienced tissue trauma during a spinal anesthesia
procedure. This shows the importance of more intensive post-operative
monitoring for patients at high risk of developing long-term pain.
In some
cases, chronic post-sectio caesarean section pain can
significantly affect the patient's quality of life, hinder daily activities,
and slow down the recovery process. Apfelbaum et al. (2017) found that patients
with chronic post-operative pain often require physical therapy and psychological
interventions to address the physical and emotional components of pain. Delayed
or inadequate treatment of chronic pain can worsen the patient's condition,
increasing the risk of psychological disorders such as anxiety and depression.
Therefore,
it is important to pay special attention to patients who experience prolonged
back pain. Ongoing pain assessment, proper management, and a multidisciplinary
approach are necessary to prevent the progression of chronic pain and ensure
optimal recovery.
4. Anesthesia Techniques and Their Effects on Pain
Spinal anesthesia techniques play a key role in the occurrence of
post-sectio caesarean back pain. The use of larger
needles or procedures that are not done carefully can cause trauma to the
tissues around the spine. This trauma increases the risk of cerebrospinal fluid
leakage (CSF), which is associated with the occurrence of back pain after
surgery (Cavallaro et al., 2014). CSF leaks often cause headaches and back
pain, which in some cases can last for a long time.
The use
of smaller atraumatic needles has been shown to reduce the incidence of tissue
trauma and CSF leakage. Some studies suggest that these small needles can
significantly reduce the risk of complications, including back pain. More
careful injection techniques and careful handling during the anesthesia procedure also help minimize the risk of pain.
In some cases, the use of smaller doses of anesthetic
medications can help reduce distension in the structure of the back,
potentially causing pain.
In
addition to needle size and technique, other factors such as the patient's
position during the spinal anesthesia procedure also
have an effect. Suboptimal positioning during the injection can cause strain on
the back and spinal muscles, which in turn increases the risk of pain.
Therefore, special attention should be paid to the patient's position during
surgery, especially in patients with a history of back pain or other
musculoskeletal problems.
In
conclusion, proper anesthesia techniques are
essential to prevent post-cesarean back pain. The use
of smaller atraumatic needles, adjusted doses of anesthesia,
and attention to the patient's position can help reduce the risk of these
complications. This suggests that improvements in spinal anesthesia
techniques can have a significant positive impact on patient clinical outcomes.
5. Post-Sectio Caesaria Pain Management
Management
of post-cesarean section back pain should be started
immediately after surgery to prevent more serious complications. Most patients
can manage back pain with the administration of simple analgesics such as
paracetamol or NSAIDs, which are usually quite effective for managing mild to
moderate pain (Qin et al., 2018). Regular use of analgesics in the first 48
hours is essential to control acute pain and speed recovery.
In more
severe cases, the use of mild opioids such as tramadol may be necessary.
However, opioid administration should be considered with caution due to the
risk of side effects such as nausea, vomiting, sedation, and dependence.
Non-pharmacological approaches are also becoming increasingly popular in the
management of post-cesarean section back pain.
Physical therapy, massage, acupuncture, and relaxation techniques have been
shown to be effective in reducing muscle tension and speeding up the recovery
process.
Chronic
pain management requires a more comprehensive approach, especially for patients
who experience back pain for more than a few weeks. Interventions such as
intensive physical therapy, stress management, and psychological support are
essential to help patients recover. Studies show that a combination of physical
and psychological therapy is effective in addressing chronic pain and
preventing more serious functional impairments (Apfelbaum et al., 2017).
Thus, the
management of post-sectio caesarean back pain should
be multidisciplinary, taking into account the technical and individual factors
of the patient. Early intervention and a comprehensive approach can help
prevent chronic pain and improve the patient's quality of life after surgery.
CONCLUSION
From the
results of the literature review, it can be concluded that post-sectio caesarean back pain with spinal anesthesia
is a frequent complication, with a prevalence of about 30% to 50%. Risk factors
such as age, body mass index (BMI), history of back pain, and anesthesia techniques play a significant role in the
occurrence of post-operative pain. Although this pain is generally temporary
and can be managed well through pharmacological and non-pharmacological
approaches, a small percentage of patients experience chronic pain that
requires more intensive treatment. Anesthesia
techniques, including needle size and type, affect the incidence of back pain,
where the use of smaller needles and careful technique can reduce the risk of
tissue trauma and cerebrospinal fluid leakage, which is a common cause of
post-operative back pain. Adjusting the dose of anesthesia
based on body weight and other factors is also important to minimize the risk.
Overall, while spinal anesthesia offers many
advantages, the risk of back pain remains and needs to be anticipated through
the optimization of anesthesia techniques as well as
holistic pain management. A multidisciplinary approach and long-term monitoring
are needed to reduce the negative impact on patients' quality of life. For this
reason, there is a need for increased training of anesthesiologists
on more careful techniques, including the use of atraumatic needles, as well as
a thorough assessment of the patient's risk factors. Post-cesarean
section pain management should use a multimodal approach with a combination of
pharmacological and non-pharmacological therapies to accelerate recovery and
reduce the risk of chronic pain. Further research is needed to examine the
effectiveness of the new approach in reducing back pain as well as long-term
management of chronic pain, with continuous patient monitoring after surgery.
REFERENCE
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