Supplementary Material for: Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

<b><i>Background:</i></b> Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. <b><i>Methods:</i></b> We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery.<b><i> Results:</i></b> In all, we included 78 studies in this review, with 32 studies concerning diagnostic investigations, 56 studies involving management strategies, and 4 studies regarding the use of neuraxial techniques for labour and delivery. <b><i>Summary:</i></b> MRI is the safest investigative modality for LBP in pregnancy. Antenatal educational programmes, exercise and steroid injections into the epidural space or sacroiliac joints may help with pain management. Worsening neurological deficits, vertebral fractures and tumours may need surgical management. There is limited evidence on challenges of performing neuraxial blocks in the peripartum period for analgesia and anaesthesia, but there is a potential for increased risk of neurological complications in parturients with pre-existing neurological deficits.

背景：腰背痛（Low Back Pain, LBP）在妊娠期极为常见，且临床管理往往不尽如人意。此类患者在分娩过程中使用椎管内镇痛与麻醉的诊断检查、合理管理及决策制定均存在诸多模糊不清之处。本系统综述总结了针对妊娠合并腰背痛患者的检查手段、管理策略及实施椎管内阻滞相关的循证依据。
方法：本研究检索了3个数据库，回顾了与妊娠合并腰背痛的诊断方式、管理策略及用于辅助分娩的椎管内技术应用相关的文献。
结果：本综述共纳入78项研究，其中32项涉及诊断检查，56项围绕管理策略，另有4项探讨了分娩过程中椎管内技术的应用。
总结：磁共振成像（Magnetic Resonance Imaging, MRI）是妊娠期腰背痛最安全的检查手段。产前教育课程、运动及硬膜外腔或骶髂关节类固醇注射均有助于疼痛管理。神经功能缺损进行性加重、椎体骨折及肿瘤患者可能需要外科干预。目前关于围产期实施椎管内阻滞以进行镇痛与麻醉所面临挑战的相关证据较为有限，但合并既往神经功能缺损的分娩产妇发生神经并发症的风险可能升高。