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Hong JH, Cho EY, Shim JW, Park KB. Comparison of postoperative back pain between paramedian and midline approach for thoracic epidural anesthesia. Anesth Pain Med (Seoul) 2022; 17:320-326. [PMID: 35918866 PMCID: PMC9346204 DOI: 10.17085/apm.22139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The development of back pain following epidural analgesia is one reason for patient refusal of neuraxial analgesia. The primary endpoint of this study was to compare the incidence and severity of back pain following midline and paramedian epidural technique. The secondary endpoint was to identify the risk factors associated with the occurrence of back pain.Methods: This prospective randomized study included 114 patients receiving thoracic epidural catheterization for pain management following upper abdominal or thoracic surgery. Patients were allocated to either the midline or the paramedian group by computer-generated randomization. An investigator who was blinded to the patient group interviewed patients at 24, and 48 h, and 3–5 days after surgery about the existence of back pain and its severity.Results: The total incidence of back pain following epidural anesthesia was 23.8% in the midline group and 7.8% in the paramedian group. The numerical rating scale of back pain was not different between the two groups at 24 h and 4 days after surgery. The paramdian technique was associated with a lower incidence of back pain than the midline technique (95% confidence interval 0.05–0.74, odds ratio 0.2, P < 0.01). However, the number of attempts, surgical position, body mass index, and duration of surgery were not associated with back pain.Conclusions: This study showed that the midline group of thoracic epidural analgesia demonstrated higher incidence of back pain than the paramedian group. However, the pain was mild in intensity and decreased with time in both groups.
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Affiliation(s)
- Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
- Corresponding Author: Ji Hee Hong, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea Tel: 82-53-258-7767 Fax: 82-53-258-6288 E-mail:
| | - Eun Young Cho
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin Woo Shim
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ki Beom Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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Hewson DW, Bedforth NM, Hardman JG. Spinal cord injury arising in anaesthesia practice. Anaesthesia 2018; 73 Suppl 1:43-50. [DOI: 10.1111/anae.14139] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Affiliation(s)
- D. W. Hewson
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - N. M. Bedforth
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - J. G. Hardman
- Anaesthesia & Critical Care; School of Medicine; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
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The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2015; 40:401-30. [DOI: 10.1097/aap.0000000000000286] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Neal JM, Kopp SL, Pasternak JJ, Lanier WL, Rathmell JP. Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2015; 40:506-25. [DOI: 10.1097/aap.0000000000000297] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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