Post-Spinal Anaesthesia Low Back Pain Prevalence and Predictors; A Multi-Centers Study from Middle East

Background: Low back pain (LBP) is a common but under-recognized complication following spinal anaesthesia. Aim of Study:We sought to determine the prevalence of new or worsened LBP among patients who underwent various surgeries under spinal anaesthesia and identify independent procedural and patient-related predictors. Methods:We performed a retrospective cohort study of 165 patients who had various surgeries under spinal anaesthesia from different hospitals in Middle East region.Patient demographics, anaesthetic details (needle gauge, approach, puncture position, number of attempts), surgical data (procedure type, duration, patient positioning) and history of pre-existing LBP were extracted from medical records.Univariate and multivariate logistic regression analysis (IBM SPSS v20) showed odds ratios (OR) and 95% confidence intervals (CI), with p < 0.05 considered significant.Results: Of 165 patients, 89 (54%) developed new or worsened LBP.On univariate analysis, large-bore needles (18-22 G) (OR 15.3; 95% CI 7.1-32.8;p < 0.001), median (midline) approach (OR 9.1; 95% CI 4.3-19.0;p < 0.001), 2 puncture attempts (OR 20.6; 95% CI 9.2-46.1;p < 0.001), lateral surgical positioning (OR 13.6; 95% CI 6.4-28.9;p < 0.001) and operative duration > 60 minutes (OR 12.3; 95% CI 5.8-26.0;p < 0.001) were significantly correlated with LBP.In multivariate modelling, only 2 puncture attempts (adjusted OR 4.1; 95% CI 1.1-15.2;p = 0.038) and longer surgery (> 60 minutes) (adjusted OR 4.1; 95% CI 1.3-12.8;p = 0.014) remained independent predictors.Hosmer-Lemeshow goodness-of-fit was satisfactory (^2 = 5.58, p = 0.47). Conclusion:More than half of patients experienced low back pain after spinal anaesthesia.Repeated dural puncture attempts and prolonged operative time independently increased risk.Strategies to achieve first-pass success-such as ultrasound guidance, optimized patient positioning, and experienced operators-and to minimize surgical duration may mitigate postoperative LBP.