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CONTROVERSIES IN A SUCCESSFUL OUTCOME OF A LOW BACK PAIN CASE REPORT WITH AN UNLIKELY AETIOLOGY
ESRA Academy. Lima G. Sep 8, 2016; 138623; 0509 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Gisela Lima
Gisela Lima

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Abstract
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Background and Aims:

Low back pain(LBP) is among the top ten leading causes on The GlobalBurden of Disease Study. Continuousepidural analgesia (CEA) is used primarily in oncologic and disc protrusioncases. Although there is no recentconsensus data regarding its use in LBP in outpatient clinic, we present asuccessful outcome case.

Methods:

Male, 58 years,presents intense LBP irradiating to leg (Lasègue+), in November 2014. CT scan revealed L3-L5 spinalstenosis, L5-S1 radiculopathy. Pain control with strong opioids and coadjutants.

In August2015, new severe crisis withfunctional incapacity and some neurologicaldeficit, refractory to conventional therapy over several months, was onlyrelieved by single shot lombar epidural (local anaesthetic, glucocorticoid,opioid), which lasted only 3 days. The concern for spondylodiscitis orpathologic fracture, led to a MRI (only possible several weeks later).

 


Results:

Anepidural tunnelled catheter was placed to relieve the incapacitating pain. Themaintenance was carried consecutively by 5 days DIBs (levobupivacaine and morphine)with total remission of symptoms and absolute impact in quality of life. MRIshowed a migrated hernia fragment compressing L4 root. Accordingly to neurosurgeon,the conduct of the case was much appropriated.

Conclusions:

Continuous epidural analgesia is effective relieving LBP and even abolishingit, as soon as all safety measures are taken to avoid eventual risks. Surgical treatmentmay be delayed without patient suffering, providing appropriate conditions inorder to counter elevated numbers of failed back surgery syndrome due to hastysurgeries. More studies need to be run in order to support its use.

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