British Journal of Anaesthesia, 2004, Vol. 92, No. 5 765-767
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Correspondence |
Obstetric epidural and chronic adhesive arachnoiditis
1 Middlesbrough, UK 2 Bradford, UK 3 Wessex, UK
| The first 150 words of the full text of this article appear below. |
Editor—We read with interest the review article on obstetric epidurals and chronic adhesive arachnoiditis by Rice and colleagues.1 This article addresses most of the issues relevant to anaesthetists and pain specialists. However, we would like to draw attention to the complications associated with long-term use of neuroaxial opioids. The authors state that a review of the literature by a panel of experts in chronic pain relief noted that the intrathecal administration of morphine and fentanyl at clinically effective concentrations appeared to be safe.2 To our knowledge, there is no evidence for chronic adhesive arachnoiditis after long-term opioid administration from human or animal data. However, catheter-tip inflammatory masses (granulomas) are increasingly reported in humans receiving long-term intrathecal opioid drugs.3 4 These are sterile masses consisting of inflammatory cells attached to the catheter tip that may or may not result in spinal cord compression. Pathophysiological causes associated with their formation incidence are:5
(i)