OP025 Local anesthetic neurotoxicity and arachnoiditis: a systematic review of cases
Bibliographic record
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as a Trainee/Resident/Fellow (no age limit) Background and Aims Arachnoiditis is a rare but devastating disorder caused by a variety of insults, one purported to be local anesthetic (LA) neurotoxicity following neuraxial blockade. We examined reported cases of arachnoiditis attributed to LA neurotoxicity to characterize the strength of association. Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registered through the Open Science Framework (https://osf.io/b6txa). The databases Medline, EMBASE, CINAHL, and Cochrane CENTRAL were searched (from inception to December 2022) for articles attributing arachnoiditis to LA following neuraxial anesthesia. Results We screened 1158 studies and 38 met inclusion criteria, all of which were case reports or series representing a total of 129 patient cases with ages ranging from 15-67 years. Over half of studies were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 76 epidurals, 47 spinals, and 6 combined spinal-epidurals (table 1). Completeness of reported data was poor (figure 1). Studies reporting the greatest number of cases and/or originating from Western countries had the least complete data. Overall, more than half (74) of the 129 patients with arachnoiditis attributed to LA neurotoxicity experienced a complicated needle or catheter insertion, including memorable paresthesia, pain, or multiple attempts, irrespective of the type of neuraxial block. Conclusions The aggregate evidence attributing arachnoiditis to LA neurotoxicity is largely outdated, incomplete, or both, and insufficient to characterize the strength of association. However, there appears to be an association between complicated or traumatic insertion and arachnoiditis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.006 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".