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Editor—The review on the topic of ‘chronic adhesive arachnoiditis’ (CAA) from obstetric epidurals by Rice and colleagues x 1 Rice, I, Wee, MYK, and Thomson, K. Obstetric epidurals and chronic adhesive arachnoiditis. Br J Anaesth. 2004; 92: 109–120 was apparently triggered by a series of articles that appeared in one of the London tabloids, fostered by some of the members of the Arachnoiditis Trust. Dark side of the moon album.

These articles were unreasonable to many of us that remember the statistics of maternal deaths in the 1970s in the UK, x 2 Morris, S, Harmer, M, and Reynolds, F. The impact of regional anaesthesia on maternal mortality. In: F Reynolds (Ed.) Regional Anaesthesia in Obstetrics. Springer-Verlag, London; 2000: 347–356 when general anaesthesia was the predominant form of analgesia; aspiration of gastric contents and difficulty with tracheal intubation were the main culprits.

I also feel that it is the right of women in labour to ask for pain relief, and anaesthetists ought to provide it for them. But we cannot deny that neuroaxial anaesthesia produces morbidity and that neurological deficits are probably one of the most serious. Unfortunately, the authors of the review lost the opportunity to assess the subject of neurological deficit and arachnoiditis (ARC) after epidural anaesthesia. Instead of being impartial, they attempted to prove that adhesive arachnoiditis does not happen as frequently as the patrons of the ‘Trust’ claimed it did and, when it does occur, they dismissed it as irrelevant. Allow me to say for the record, that I do not belong to the Arachnoiditis Trust and I do not agree with their attempt to ban epidural anaesthesia for women in labour. Properly executed, epidural analgesia is, at the present time, the safest approach. However, by focusing mostly on the old concept of CAA, the authors of the review failed to recognize that ARC is an integral feature in most injuries to the intrathecal neural structures resulting in a variety of neurological deficits occurring after spinal interventions.

X 3 Aldrete, JA and Ghaly, RF. Postlaminectomy pseudomeningocele: an unexpected cause of low back pain. 1995; 20: 75–79 , x 4 Aldrete, JA. In: JA Aldrete (Ed.) Arachnoiditis: the Silent Epidemic. Futuremed, Denver; 2000: 7–18 These causes include: myelograms; spinal or epidural anaesthesia; invasive pain relief procedures; infections and blood entering the cerebrospinal fluid (CSF) from epidural blood patches; haematomas; trauma; or spinal operations. The arachnoid is now recognized as an active organ that responds to any invasion by initiating an inflammatory response proportional to the degree of injury. This reaction lasts ∼2 months; if not treated, it may progress into a chronic proliferative phase in which scarring, fibrosis and adhesions become permanent.