title: Trigger point injections for myofascial pain during epidural analgesia for labor.
abstract: OBJECTIVE
  Myofascial pain is the leading cause of chronic low back pain and in most cases can be successfully resolved with trigger point injections of local anesthetics. This type of pain can exist during pregnancy and exceed the analgesia provided by an epidural for labor.
  
  
  METHODS
  A 31-year-old primiparous woman received an epidural infusion for labor analgesia. Despite complete resolution of labor pain and a solid, bilateral T10 block, the patient reported discomfort at two discrete locations in her right lumbar paraspinous muscle.
  
  
  RESULTS
  The administration of local anesthetic via trigger point injections resulted in successful palliation of the myofascial pain.
  
  
  CONCLUSIONS
  Myofascial pain can be an etiology of back pain in the parturient. Trigger point injections, even when used concomitantly with a functioning epidural infusion, can be a valuable aid for the provision of complete analgesia.
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Tsen
authors.forename: W R
authors.initials: WR
authors.lastname: Camann
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D009209:Myofascial Pain Syndromes / Q000188:drug therapy*; D011247:Pregnancy
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine