Association Between Perioperative Neuraxial Local Anesthetic Neurotoxicity and Arachnoiditis: A Narrative Review of Published Reports

( Reg Anesth Pain Med . 2024;49:726–750. doi:10.1136/rapm-2023-104941) This review examines the association between neuraxial anesthesia and arachnoiditis, a serious inflammatory condition affecting the pia-arachnoid of the spinal cord and leading to neurologic dysfunction. Due to the severe consequences of arachnoiditis and its complex causes, there is a growing interest in understanding whether local anesthetics contribute to its development. While previous studies have suggested a potential connection, much of the existing literature lacks consistency, is outdated, or fails to isolate local anesthetics as the sole cause. This review systematically analyzed reported cases of arachnoiditis following neuraxial anesthesia, seeking to determine whether an actual causal link exists.