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British Journal of Anaesthesia, 2004, Vol. 92, No. 1 109-120
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Review Article

Obstetric epidurals and chronic adhesive arachnoiditis

I. Rice*,1, M. Y. K. Wee2 and K. Thomson3

1 Shackelton Department of Anaesthesia, Southampton General Hospital, Tremona Road, Shirley, Southampton SO14 6YD, UK. 2 Department of Anaesthesia, Poole Hospital NHS Trust, Poole, UK. 3 Department of Anaesthesia, North Hampshire Hospital, UK

*Corresponding author. E-mail: isobelrice@yahoo.co.uk

It has been suggested that obstetric epidurals lead to chronic adhesive arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over its symptomatology. This review outlines the pathological, clinical, and radiological features of the disease. The proposed diagnostic criteria for CAA are: back pain that increases on exertion, with or without leg pain; neurological abnormality on examination; and characteristic MRI findings. Using these criteria, there is evidence to show that epidural or subarachnoid placement of some contrast media, preservatives and possibly vasoconstrictors, may lead to CAA. No evidence was found that the preservative-free, low concentration bupivacaine with opioid mixtures or plain bupivacaine currently used in labour lead to CAA.

Br J Anaesth 2004; 92: 109–20


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