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British Journal of Anaesthesia, 2004, Vol. 92, No. 6 902-903
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Correspondence

Obstetric epidurals and chronic adhesive arachnoiditis

L. Talbot1, C. Lewis2, C. D. D. Hutter3, I. Rice4 and M. Y. K. Wee4

1 Torquay, UK 2 Derbyshire, UK 3 Nottingham, UK 4 Isle of Wight, UK

The first 150 words of the full text of this article appear below.

Editor—We welcome Rice and colleagues’ review1 of obstetric epidurals and chronic adhesive arachnoiditis (CAA), but are disappointed with the confusing and imprecise presentation of data and concepts, some of which have now been superseded.

There is indeed no definite evidence for a link between CAA and epidural analgesia as currently practised in the UK with low-concentration bupivacaine. However, insufficiency of evidence does not mean that obstetric epidural analgesia does not pose a significant risk for the development of CAA. Nor, given modern systems for data collection and analysis, would it require an ‘enormous prospective study...over many years’ to obtain such evidence. In fact, Holdcroft and colleagues’ 1995 study2 over one year confirmed seven cases of persistent neurological deficit after 48 006 deliveries, of which 13 633 were associated with epidural or spinal analgesia. These were unfortunately not followed up with clinical interview or MRI, but the time scale and numbers . . . [Full Text of this Article]


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