Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20210063
Brazilian Journal of Pain
Case Report

Sacroiliac infiltration in pregnant women guided by ultrasound. Case report

Infiltração sacroilíaca em gestante guiada por ultrassom. Relato de caso

Fábio Farias de-Aragão

Downloads: 0
Views: 307

Abstract

BACKGROUND AND OBJECTIVES: Pregnancy-related pelvic pain (PRPP) is one of the most frequent causes of pain during pregnancy, which can result in significant physical disability. It is often undertreated, as it is a condition considered normal during pregnancy and there is fear that the treatment may cause changes in the pregnant woman and the fetus. The objective of this study was to report a case of PRPP, its treatment with sacroiliac joint infiltration guided by ultrasound and to perform a literature review.

CASE REPORT: Pregnant woman at 35 weeks of gestation, developing PRPP originating from the left sacroiliac joint. She underwent ultrasound-guided joint infiltration with 5mL of 0.5% ropivacaine and 20mg of methylprednisolone. The patient had no pain after the procedure and remained so after delivery.

CONCLUSION: Despite the few cases described in the literature, the use of pain intervention treatment in pregnant women seems safe and effective.

Keywords

Pelvic girdle pain, Pregnancy, Sacroiliac joint, Ultrasonography interventional

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor pélvica relacionada à gestação (DPRG) é uma das causas mais frequentes de dor, podendo causar incapacidade física significativa. É muitas vezes subtratada, pois é uma condição considerada normal durante a gestação e há receio de que o tratamento possa causar alterações na gestante e no feto. O objetivo deste estudo foi relatar o caso de gestante com DPRG; e o tratamento com infiltração de articulação sacroilíaca guiada por ultrassom e realizar revisão da literatura.

RELATO DO CASO: Gestante com 35 semanas, evoluindo com DPRG com origem em articulação sacroilíaca esquerda. Foi submetida à infiltração da articulação guiada por ultrassom com 5mL de ropivacaína a 0,5% e 20mg de metilprednisolona. A paciente apresentou ausência de dor após o procedimento, permanecendo assim após o parto.

CONCLUSÃO: Apesar de poucos casos descritos na literatura, a utilização do tratamento de intervenção em dor em gestantes parece seguro e eficaz.

Palavras-chave

Articulação sacroilíaca, Dor da cintura pélvica, Gravidez, Ultrassonografia de intervenção

References

Tan EK, Tan EL. Tan. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):791-802.

Gallo-Padilla D, Gallo-Padilla C, Gallo-Vallejocy FJ, Gallo-Vallejo JL. Lumbalgia durante el embarazo. Abordaje multidisciplinar. Semergen. 2016;42:e59-64.

Robinson HS, Eskild A, Heiberg E, Eberhard-Gran M. Pelvic girdle pain in pregnancy: the impact on function. Acta Obstet Gynecol Scand. 2006;85(2):160-4.

Hansen A, Jensen DV, Wormslev M, Minck H, Johansen S, Larsen EC. Symptom-giving pelvic girdle relaxation in pregnancy. II: symptoms and clinical signs. Acta Obstet Gynecol Scand. 1999;78(2):111-5.

Weis CA, Barrett J, Tavares P, Draper C, Ngo K, Leung J. Prevalence of low back pain, pelvic girdle pain, and combination pain in a pregnant Ontario population. J Obstet Gynaecol Can. 2018;40(8):1038-43.

Tavares P, Barrett J, Hogg-Johnson S, Ho S, Corso M, Batley S. Prevalence of low back pain, pelvic girdle pain, and combination pain in a postpartum Ontario population. J Obstet Gynaecol Can. 2020;42(4):473-80.

Aragao FF. Pregnancy-related lumbosacral pain. BrJP. 2019;2(2):176-81.

Walters C, West S, A Nippita T. Pelvic girdle pain in pregnancy. Aust J Gen Pract. 2018;47(7):439-43.

Starzec M, Truszczynska-Baszak A, Tarnowski A, Rongies W. Pregnancy-related pelvic girdle pain in polish and Norwegian women. J. Manip Physiol Ther. 2019;42(2):117-24.

Kovacs FM, Garcia E, Royuela A, González L, Abraira V. Spanish Back Pain Research Network: Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: A multicenter study conducted in the Spanish National Health Service. Spine. 2012;37(17):1516-33.

Meucci RD, Percevall AH, Lima DR, Cousin E, Mamitt LP, Pizzatol P. Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil. Rev Bras Epidemiol. 2020;23:E200037.

Wuytack F, Begley C, Daly D. Risk factors for pregnancy-related pelvic girdle pain: a scoping review. BMC Pregnancy Childbirth. 2020;20(1):739.

Robinson HS, Mengshoel AM, Bjelland EK, Vøllestad NK. Pelvic girdle pain, clinical tests and disability in late pregnancy. Man Ther. 2010;15(3):280-5.

Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard H. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskel Disord. 2016;17:276.

Talbot L, Maclennan K. Physiology of pregnancy. Anaesth Intens Care Med. 2016;17(7):341-5.

Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low back pain and pelvic girdle pain in pregnancy. J Am Acad Orthop Surg. 2015;23(9):539-49.

Ireland ML, Ott SM. The effects of pregnancy on the musculoskeletal system. Clin Orthop Relat Res. 2000;372:169-79.

Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil. 2005;84(3):180-92.

Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9:15.

van Tulder M, Becker A, Bekerring T. European guidelines on the management of acute nonspecific low back pain in primary care [European Commission Research Directorate General Web site]. 2004.

Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.

Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-52.

Albert HB, Godskesen M, Westergaard JG. Incidence of four syndromes of pregnancy-related pelvic joint pain. Spine. 2002;27(24):2831-4.

Baysinger CL. Imaging during pregnancy. Anesth Analg. 2010;110(3):863-7.

Kanal E, Barkovich AJ, Bell C, Borgstede JP, WG Jr Bradley, Froelich JW. Expert Panel on MR Safety: ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 2013;37(3):501-30.

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1(2):137-41.

Simões LC, Teixeira-Salmela LF, Wanderley EL, Barros RR, Laurentino GE, Lemos A. Adaptação transcultural do “Pelvic Girdle Questionnaire” (PGQ) para o Brasil. Acta Fisiatr. 2016;23(4):166-71.

Rathmell JP, Viscomi CM, Ashburn MA. Management of nonobstetric pain during pregnancy and lactation. Anesth Analg. 1997;85(5):1074-87.

Fouad AZ, Ayad AE, Tawfik KAW, Mohamed EA, Mansour MA. The success rate of ultrasound guided sacroiliac joint steroid injections in sacroiliitis. are we getting better? Pain Pract. 2021;21(4):404-10.

Sehmbi H, D’Souza H, Bhatia A. Low back pain in pregnancy: investigations, management, and role of neuraxial analgesia and anaesthesia: a systematic review. Gynecol Obstet Invent. 2017;82(5):417-36.

Hasegawa Y, Iwata H. Chronic pelvic girdle relaxation. Jpn J Rheumatol. 1999;9:391-5.

Hurdle MFB, McHugh R, Schwendemann W, Psimos C, Smith J. Poster 128: ultrasound guided sacroiliac joint injection in pregnancy: a case series. Arch Phys Med Rehabil. 2007;88(9):E45-6.

Vincent R, Blackburn J, Wienecke G, Bautista A. Sacroiliac joint pain in pregnancy: a case report. A A Pract. 2019;13(2):51-3.

Colmek S. Ultrasound-guided interventions during pregnancy for lumbosacral pain unresponsive to conservative treatment: a retrospective review. J Clin Ultrasound. 2021;49(1):20-7.

Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen FL. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the regionof the sacroiliac joint. Clin Exp Rheumatol. 2002;20(1):52-4.

Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol. 2014;123(5):997-1002.

Mack KA, Jones CM, Paulozzi LJ. Vital signs: overdoses of prescription opioid pain relievers and other drugs among women—United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2013;62(26):537-42.

Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017;43(3):489-502.

Hagai A, Diav-Citrin O, Shechtman S, Ornoy A. Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study. J Am Dent Assoc. 2015;146(8):572-80.

Bandoli G, Palmsten Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017;43(3):489-502.

van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB. Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv. 2005;60(1):57-70.

. .


Submitted date:
04/13/2021

Accepted date:
08/16/2021

61e71b8ea953955748758a74 brjp Articles

BrJP

Share this page
Page Sections