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Women with backache often present to the anaesthetist in the antenatal period. Referral to the obstetric physiotherapist, lumbar support, simple analgesia and transcutaneous electrical nerve stimulation (TENS) may all be of help.

With the evidence as it currently stands, there is no need to warn women of the risk of backache when preparing to perform epidural or spinal anaesthesia. However, many women ask about this complication, especially at antenatal classes, and the best approach is to inform them of the high risk of long-term backache associated with pregnancy and childbirth and to reassure them that epidurals do not appear to increase this risk.

The woman who presents with severe backache or a long history of back trouble in the antenatal clinic should be warned that it is very likely that this will continue after childbirth. Epidural analgesia should not be contraindicated in these cases but it may sometimes be more painful having an epidural sited in a sensitive back. A 'mobile' technique should be preferred, to allow the patient to move freely in labour, and care should be taken to avoid unnatural postures that will unduly stress the ligaments. Support of lumbar lordosis and prevention of hyperextension at the hips is helpful.

Midwives should be alerted to refer acute, localised backache after epidural to the anaesthetist. Management should include a full neurological examination, early referral to a neurologist and an early magnetic resonance imaging scan to exclude haematoma or abscess.

Localised tenderness and limitation of movement may be due to a small haemat-oma in the interspinous ligament or paraspinous muscles and these will often respond to physiotherapy.

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