Background
45% of pregnant women experienced low back pain. Among them, 25% persons have severe pain. Treatment suggested TENS, acupuncture, physical therapy et al. This case presented that 32 weeks pregnant woman patient had severe acute low back pain and leg pain which was treated with epidural catheter and intermittent local analgesics injection.

Case report
The 32 weeks gestational pregnant woman visited emergency room and complained low back pain and right leg pain. The pain which was from right gluteal region to leg with numb, evoked 3 days ago and visual analogue scale (0= no pain, 10= very severe pain). At emergency room, the position of patient was stand and leaned to desk or bed with flexion back near right angle which made pain less severe but VAS 8-9. The patient did not keep supine position or decubitus for several minutes which caused pain and numb. Although pethidine 25mg was injected intramuscular to reduce pain, Magnetic resolution images (MRI) could not be taken because the patient could not keep supine position. Therefore lumbar 4/5 and 5/S1 disc protrusion was confirmed by computed tomography. Consultation was taken and we inserted epidural catheter. The catheter position was checked with fluoroscopy because we worried about intravenous injection of local anesthetics. The catheter was confirmed epidural space about L3/4 and 0.15% ropivaciane 6 ml was injected. The pain reduced to VAS 4-5 after several minutes later and the patient could lie on the bed. Fetal heart rates was normal after injection. Twice injection of 0.15% ropivacaine 6 ml reduced pain VAS 2-3 and the patient discharged 5 day later. Any complications were not observed.
discussion
Local anesthetics injection though epidural catheter attenuates pain evoked by inflammatory substances of disc protrusion. We could pain control by epidural catheter insertion without any side effects of both mother and baby. 

Learning points
Epidural catheter insertion and intermittent local anesthetic injection was effective methods for treatment of low back and leg pan in pregnant woman without side effects.
Referance
1.	P Kristiansson, K Svärdsudd, B von Schoultz. Back pain during pregnancy: a prospective study spine. 1996; 21: 702-8.
2.	Pishnamaz M, Sellei R, Pfeifer R, Lichte P, Pape HC, Kobbe P. Low back pain during pregnancy caused by a sacral stress fracture: a case report. J Med Case Rep. 2012 4;6:98. 
Learning points

Treatment of low back and leg pain with epidural catheter insertion in pregnant woman