Article Text
Abstract
Background/importance Arachnoiditis is a rare but devastating disorder caused by various insults, one of which is purported to be local anesthetic neurotoxicity following neuraxial blockade. However, the relationship between local anesthetics administered into the neuraxis and the development of arachnoiditis has not been clearly elucidated.
Objective We aimed to summarize the existing complex body of literature and characterize both the essential features and strength of any association between neuraxial local anesthetic neurotoxicity and arachnoiditis with a view toward mitigating risk, enhancing prevention, and refining informed consent discussions.
Evidence review We reviewed all published reports of arachnoiditis attributed to local anesthetic neurotoxicity following perioperative neuraxial anesthesia. This narrative review was based on a systematic search methodology, which included articles published up until December 2022.
Findings Thirty-eight articles were included, comprising 130 patients, over one-half of which were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 78 epidurals, 48 spinals, and 5 combined spinal-epidurals, mostly for obstetrics. Reporting of essential procedural data was generally incomplete. Overall, at least 57% of patients experienced complicated needle/catheter insertion, including paresthesia, pain, or multiple attempts, irrespective of technique. The onset of neurological symptoms ranged from immediate to 8 years after neuraxial blockade, while the pathophysiology of arachnoiditis, if described, was heterogeneous.
Conclusions The existing literature attributing arachnoiditis to local anesthetic neurotoxicity is largely outdated, incomplete, and/or confounded by other potential causes, and thus insufficient to characterize the features and strength of any association.
- Anesthesia, Local
- Drug-Related Side Effects and Adverse Reactions
- Injections, Spinal
- Neurologic Manifestations
- Neurotoxicity Syndromes
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Footnotes
Twitter @CTA_Brenna
Presented at the 6th World Congress on Regional Anaesthesia & Pain Medicine (Paris, FR) and the Anesthesiology 2023 Annual Meeting (San Francisco, CA).
Contributors CB contributed to study and search algorithm design, screening and data collection, data analysis, study coordination, drafting the initial manuscript, preparing exhibits, and revising the draft manuscript. SK contributed to study and search algorithm design, screening and data collection, data analysis, drafting the initial manuscript, preparing exhibits, and revising the draft manuscript. CP contributed to data analysis, study coordination, drafting the initial manuscript, preparing exhibits, and revising the draft manuscript. RB contributed to study design, data analysis, preparing exhibits, revising the draft manuscript, and supervision of the project. All authors serve as guarantors of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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