Treatment of Low Back Pain and Sciatica by Local Anesthetic Injection through Epidural Catheter in Pregnant Woman

Abstract

Lower back pain in pregnant women is common and 30% of them require bed rest as a result [1]. Meanwhile, sciatica associated intractable pain occurs in approximately 1:10,000 pregnant women [1]. The occurrence of lower back pain and its severity are affected by hormone changes, weight gain, shift in center of gravity leading to disc bulging or herniation and relaxin levels, which contribute to the sliding mobility of the sacroiliac joints, widening of the pubic symphysis, and laxity of the posterior longitudinal ligament [2]. Conservative therapy, such as stretching, acupuncture, and core training, should be tried as first line interventions and analgesics, such as nonsteroidal anti-inflammatory drugs, may be recommended following the risk classification guidelines for drug use in pregnancy. In non-pregnant patients, disc length is a predictor for surgical treatment or nerve block success [3]. However, there are no definitive guidelines for nerve block and drug combinations in pregnant women with sciatica or lower back pain. This case report aimed to investigate the efficacy of epidural catheter insertion and intermittent local analgesic administration in a pregnant woman, presenting with severe, acute lower back pain and sciatica.