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Obstetric epidurals and chronic adhesive arachnoiditis
1Shackelton Department of Anaesthesia, Southampton General Hospital, Tremona Road, Shirley, Southampton SO14 6YD, UK. isobelrice@yahoo.co.uk
British Journal of Anaesthesia
|December 11, 2003
Summary
Obstetric epidurals may cause chronic adhesive arachnoiditis (CAA). However, current labor epidurals using preservative-free bupivacaine do not show evidence of causing CAA.
Area of Science:
- Neurology
- Anesthesiology
- Radiology
Background:
- Chronic adhesive arachnoiditis (CAA) is a poorly understood neurological condition.
- Obstetric epidurals have been implicated as a potential cause of CAA.
Purpose of the Study:
- To review the pathological, clinical, and radiological features of CAA.
- To evaluate the link between obstetric epidurals and CAA.
Main Methods:
- Literature review of pathological, clinical, and radiological findings.
- Analysis of proposed diagnostic criteria for CAA.
- Assessment of evidence linking epidural agents to CAA.
Main Results:
- Proposed CAA diagnostic criteria include exertional back pain, neurological deficits, and specific MRI findings.
- Evidence suggests certain contrast media, preservatives, and vasoconstrictors may induce CAA.
- No evidence links current labor epidurals (preservative-free bupivacaine with opioids or plain bupivacaine) to CAA.
Conclusions:
- CAA diagnosis requires specific clinical and radiological evidence.
- Certain epidural agents are associated with CAA development.
- Modern labor epidurals are unlikely to cause CAA.