Association between perioperative neuraxial local anesthetic neurotoxicity and arachnoiditis: a narrative review of published reports.

Autor:	Brenna CTA; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada., Khan S; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Poots C; Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada., Brull R; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada richard.brull@uhn.ca.; Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada.; Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2024 Oct 08; Vol. 49 (10), pp. 726-750. Date of Electronic Publication: 2024 Oct 08.
DOI:	10.1136/rapm-2023-104941
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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