The Aword

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The issue of whether epidural anaesthesia is a causative factor in arachnoiditis arouses considerable controversy: this is unsurprising bearing in mind that probably the most common usage is for pain relief during childbirth.

This could therefore be an issue of widespread implications.

Epidural and spinal anaesthesia results from the interaction of local anaesthetic agents with nerves, primarily those in the subarachnoid space.

Local anaesthetic preparations contain various preservatives, some of which are known to be neurotoxic. Ionic forms are CNS toxic ([i])

There are a number of documented cases of arachnoiditis secondary to epidural anaesthesia, and indeed, it is recognised as a rare complication of this procedure.

However, the true incidence remains unknown, as most studies of the adverse effects of anaesthesia tend to concentrate on the immediate and short-term problems.

In addition, studies concerning long-term back pain following epidurals may fail to include cases of neurological damage and arachnoiditis continues to be significantly under-diagnosed.

The following evidence is presented to demonstrate the need to investigate this problem more closely: if nothing else, to exclude arachnoiditis as a significant risk in what is a commonplace procedure.

[i] Dr. J E Tetzlaff, Cleveland Clinic Foundation Department of General Anesthesiology Internet Site