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Background and Aims Arachnoiditis is a rare but devastating disorder caused by a variety of insults, one purported to be local anesthetic (LA) neurotoxicity following neuraxial blockade. We examined reported cases of arachnoiditis attributed to LA neurotoxicity to characterize the strength of association.
Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registered through the Open Science Framework (https://osf.io/b6txa). The databases Medline, EMBASE, CINAHL, and Cochrane CENTRAL were searched (from inception to December 2022) for articles attributing arachnoiditis to LA following neuraxial anesthesia.
Results We screened 1158 studies and 38 met inclusion criteria, all of which were case reports or series representing a total of 129 patient cases with ages ranging from 15-67 years. Over half of studies were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 76 epidurals, 47 spinals, and 6 combined spinal-epidurals (table 1). Completeness of reported data was poor (figure 1). Studies reporting the greatest number of cases and/or originating from Western countries had the least complete data. Overall, more than half (74) of the 129 patients with arachnoiditis attributed to LA neurotoxicity experienced a complicated needle or catheter insertion, including memorable paresthesia, pain, or multiple attempts, irrespective of the type of neuraxial block.
Conclusions The aggregate evidence attributing arachnoiditis to LA neurotoxicity is largely outdated, incomplete, or both, and insufficient to characterize the strength of association. However, there appears to be an association between complicated or traumatic insertion and arachnoiditis.
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