Post-spinal backache after cesarean section: A systematic review

Abstract

The most frequent patients' complaints of spinal anesthesia are post-spinal headache and post-spinal backache. As many as 13.4% of the patients have backache as the major reason for refusing spinal anesthesia. This systematic review was conducted using keywords: 'post spinal backache,' 'post spinal backpain,' 'caesarean section,' 'caesarean delivery,' and 'obstetric,' which were combined using Boolean operator 'OR' and 'AND.' The time filter was set from 2000 until 2020. We included six studies that included a total of 2721 subjects who underwent elective cesarean delivery under spinal anesthesia, of which 675 subjects or about 24% of them experienced backache. Many factors were thought to be responsible for the incidence of post-spinal backache. Trauma due to needle injection, hematoma, and excessive stretching of ligaments until infection which leads to abscess are possibly being the main causes of post-spinal backache. There are several efforts that can be made to reduce the risk of post-spinal backache, such as using a small needle without an introducer, performing spinal anesthesia with a paramedian approach, and reducing the number of attempts.