Does Epidural During Labor Lead to Chronic Low Backpain? A Malaysian Retrospective Cohort Study.

Objectives: The question as to whether epidural analgesia during labor can cause subsequent chronic low backpain has become a concern of late but this association has not been tested locally and remains controversial. The objective of this retrospective cohort study was to determine whether epidural analgesia during labor was associated with low backpain six months after delivery. Methods: We contacted 200 nulliparous women who had delivered their first baby by normal vaginal delivery via telephone at six months after delivery. Onehundred women had received epidural analgesia for labor and 100 had not. The women were asked to quantify their backpain (yes/no, numeric rating score, and impairment of daily function). Differences between the epidural and the nonepidural groups were tested by using independent t-test and Chi-squared test, and logistic regression was used to control for confounding factors. Results: The baseline demographic and obstetric characteristics between the two groups were similar except in terms of body mass index, employment status and duration of labor. The prevalence of new onset low backpain at six months after delivery was significantly higher in women who had received epidural analgesia during labor than those who had not (28% versus 9%, P = 0.001). However, there was no different between the two groups on numeric rating score or level of impairment of daily function, with the pain being moderate in severity and the functional impairment being minimal in both groups. The adjusted odds ratio of low back pain at six months (epidural versus non-epidural) was 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: This retrospective cohort study demonstrated an association between epidural analgesia during labor and chronic low backpain which may not be causal but suggested that a randomized controlled study is warranted. [ABSTRACT FROM AUTHOR]