Randomised study of long term outcome after epidural versus non-epidural analgesia during labour

doi:10.1136/bmj.325.7360.357

BMJ 2002;325:357 ( 17 August )

Papers

Randomised study of long term outcome after epidural versus non-epidural analgesia during labour

Charlotte J Howell, consultant anaesthetist, ^a Tracy Dean, research physiotherapist, ^b Linda Lucking, research coordinator, ^a Krysia Dziedzic, clinical trialist, physiotherapy, ^c Peter W Jones, professor of medical statistics, ^d Richard B Johanson, professor of obstetrics. ^a

^a Academic Department of Obstetrics and Gynaecology, North Staffordshire Hospital (NHS) Trust, Stoke on Trent, Staffordshire ST4 6QG, ^b Physiotherapy Department, Staffordshire Rheumatology Centre, Haywood Hospital, Burslem, Stoke on Trent, ^c Department of Physiotherapy Studies and Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, ^d Department of Mathematics, Keele University, Keele, Staffordshire ST5 5BG

Correspondence to: C J Howell charlotte{at}kogs.freeserve.co.uk

Objective: To determine whether epidural analgesia duringlabour is associated with long termbackache.
Design: Follow up after randomised controlled trial.Analysis by intention totreat.
Setting: Department of obstetrics and gynaecology atone NHStrust.
Participants: 369 women: 184 randomised to epidural group(treatment as allocated received by 123) and 185 randomised tonon-epidural group (treatment as allocated received by 133). Inthe follow up study 151 women were from the epidural group and155 from the non-epiduralgroup.
Main outcome measures: Self reported low back pain, disability, andlimitation of movement assessed through one to one interviewswith physiotherapist, questionnaire on back pain and disability,physical measurements of spinalmobility.
Results: There were no significant differences betweengroups in demographic details or other key characteristics. Themean time interval from delivery to interview was 26 months. Therewere no significant differences in the onset or duration of lowback pain, with nearly a third of women in each group reportingpain in the week before interview. There were no differences inself reported measures of disability in activities of daily livingand no significant differences in measurements of spinalmobility.
Conclusions: After childbirth there are no differencesin the incidence of long term low back pain, disability, or movementrestriction between women who receive epidural pain relief andwomen who receive other forms of painrelief.

What is already known on this topic
Previous research has suggested an association between epidural analgesia during labour and low back pain

It is not known whether this association is causal

What this study adds
This long term follow up study found no evidence of a causal link between epidural analgesia during labour and low back pain

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Rapid Responses:

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BMJ should publish a correction about the front cover: Michael Rosen
bmj.com, 19 Aug 2002 [Full text]
Why 'intention to treat'?: James Austin
bmj.com, 21 Aug 2002 [Full text]
More details of anaesthetic technique: Julian P Stone
bmj.com, 21 Aug 2002 [Full text]
Re: Potentially a septic technique for epidurals: Andrew W Ross
bmj.com, 24 Aug 2002 [Full text]
Re: Why 'intention to treat'?: Neil F Moran
bmj.com, 25 Aug 2002 [Full text]
Re: Why 'intention to treat'?: John A Laurenson
bmj.com, 27 Aug 2002 [Full text]
Epidurals and backache: not again?: Felicity Reynolds
bmj.com, 27 Aug 2002 [Full text]
Re: Re: Potentially a septic technique for epidurals: Martin N. Scanlon
bmj.com, 27 Aug 2002 [Full text]
Re: Re: Why 'intention to treat'?: Martin N. Scanlon
bmj.com, 27 Aug 2002 [Full text]
Re: Re: Re: Potentially a septic technique for epidurals: John A Crowhurst
bmj.com, 3 Sep 2002 [Full text]
Long term back pain after labour analgesia: Ulisse Corbanese, et al.
bmj.com, 18 Sep 2002 [Full text]
Re: Re: Why 'intention to treat'?: Bernhard H Heidemann
bmj.com, 27 Oct 2002 [Full text]