Assessment of the Association Between Neuraxial Anesthesia and Back Pain After Delivery: A Systematic Review and Meta-Analysis.

Background: Back pain after delivery both under cesarean section and spontaneous vaginal delivery is the most common pregnancy-related musculoskeletal problem. There are multiple studies that emphasize the effect of epidural anesthesia and spinal anesthesia on the incidence and severity of postdelivery back pain. There are others stating no association between the two. Objective: The aim of this study is to summarize the relationship between back pain after delivery and neuraxial anesthesia. Methods: Studies identified from database: Cochrane Library, The Virtual Health Library, National Library of Medicine PubMed, Google Scholar, and citation searching with both experimental and observational study design were included. Exposed and nonexposed incidence of back pain was extracted to analyze the pooled odds ratio assessing the association of postpartum back pain and neuraxial anesthesia. Heterogeneity was checked across studies using Cochrane Q test statistic and I ². Small study effect was assessed using a funnel plot graphically and nonparametric rank correlation (Begg) test. Results: Four RCT and 11 observational studies were identified for analysis. The studies included mothers delivering under cesarean section and vaginal delivery with epidural anesthesia, spinal anesthesia, and combined spinal epidural anesthesia. Based on the 15 studies included in this meta-analysis, the pooled odds ratio according to random effect restricted maximum-likelihood model was 1.2 (95% CI (0.77-1.86)) with p value = 0.43. There was a significant heterogeneity with I ² = 97.76%, H ² = 44.58, and Cochrane Q statistics p value = 0.001. Conclusion: Our result suggests neuraxial anesthesia may not be the cause or the risk factor for the overwhelmingly high incidence of back pain women experience after delivery.