Incidence and associated factors of acute back pain following spinal anaesthesia in mothers delivered by caesarean section at Kawempe National Referral Hospital

Abstract

Background: Spinal anaesthesia is a reliable and easy technique frequently used in anaesthetic practice. Post spinal back pain is one of the complications causing discomfort in patients, leading to rejection of its use for next operations. This study set out to determine the incidence and associated factors of acute back pain following spinal anaesthesia in mothers delivered by Caesarean section at Kawempe National Referral Hospital (KNRH). Methods: This study was a prospective cohort study. The sample size consisted of 424 mothers who underwent caesarean section from January to March of 2020 at KNRH. Patients were recruited consecutively at the obstetric and labour wards daily. Data were collected using a questionnaire and entered into Epi-data 3.0. Stata 15 was used to analyse the collected data. Bivariate logistic regression analysis was carried out, and factors with a P≤0.2 were considered for multivariate analysis. Multivariate logistic regression models were fitted for the data. The goodness of fit of the final model was assessed using the Hosmer Lemeshow test. The odds ratios and their 95% confidence intervals were determined. Results: The incidence of acute back pain at 24 hours, 48 hours, and 72 hours post operatively displayed 18.4%, 0.6% and 0% respectively. The overall incidence was 18.85%. Factors associated with development of acute back pain at 24 hours post-operatively, were duration of surgery (AOR = 0.459, 95% CI: 0.244, 0.865), number of redirections of spinal needle (AOR = 2.833, 95% CI: 1.12-7.220), number of attempts (AOR=2.822, 95% CI: 1.354-5.881). At 48 hours post-operatively, factor was number of attempts (AOR= 6.944, 95% CI: 1.665-17.264) while at 72 hours post-operatively, the factors were occupation (AOR = 36.889, 95% CI:2.718 – 500.587), level of education (AOR= 0.067, 95% CI:0.005-0.977), experience of anaesthetist (AOR= 21.215, 95% CI: 3.057-147.218), history of previous caesarean section (AOR = 31.844, 95% CI: 1.367 – 741.691). Conclusion: Acute back pain following spinal anaesthesia at KNRH occurred in 18.85% of the mothers who underwent caesarean section under spinal anaesthesia. Factors associated were number of attempts, number of needle redirections, duration of the surgery, occupation, level of education, history of previous caesarean section and experience of anaesthetist.