Persistent Neurologic Deficit and Adhesive Arachnoiditis following Intrathecal 2-Chloroprocaine Injection

Mépivacaïne rachidienne additionnée de fentanyl pour une arthroscopie du genou en ambulatoire: une étude randomisée contrôlée

“…23,24 However in the early 1980s, neurological deficits were observed after apparent intrathecal injection of a chloroprocaine solution containing sodium bisulfite intended for epidural administration. [25][26][27] Although bisulfite-free formulations of chloroprocaine are available for clinical use and are currently being investigated for outpatient spinal anesthesia with favourable results, 28 the relative toxicities of this anesthetic and its excipients are not clearly established; therefore, further work is required to clarify the safety profile of preservative-free chloroprocaine for future use. 29 Despite its favourable pharmacokinetic profile for ambulatory surgery, the popularity of mepivacaine has likely been stunted by its association with TNS.…”

Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report

“…In addition to the vascular disturbances of the spinal cord, arachnoiditis following chemical damage to the spinal cord and nerve roots, possibly induced by the anaesthetic drug or its preservative, may have caused the deterioration of the paralysis (Braham, 1958;Kliemann, 1975;Reisner, 1980;Sghirlanzoni, 1989). Not only post-ischaemic spinal oedema but also a direct chemical effect on the spinal cord followed by arachnoiditis are suggested, because a myelogram showed changes suspicious of arachnoiditis, EMGs exhibited denervation potentials in the lumber myotomes, and there was slow progressive deterioration of the paralysis.…”

Epidural anaesthesia and spinal arachnoiditis

“…The possibility that epidural anaesthesia, the only common point in the history of all our patients, was responsible for arachnoiditis is suggested by the absence of other possible causes; the chronological relationship between onset of illness and the anaesthetic procedure (this period was short in all patients except number 5, although even thc interval in this case does not exceed those reported previously);11,22 and the previous descriptions of similar cases in the literature. 8- 20 The lack of history of meningitis and CSF abnormalities rules out infection as the cause of arachnoiditis, even though early CSF examinations were not performed and two patients were known to have had transient headache and lumbar pain after epidural anaesthesia. Other authors13~16~23 have suggested that contamination of anaesthetic instruments may induce an arachnoiditic reaction.…”