Keywords: chlorhexidine, arachnoiditis, lumbar puncture, neurotoxicity (PubMed Search)
Chlorhexidine (CHG) has rapidly become the antiseptic of choice for most skin preparation prior to any percutaneous procedures including:
The Chlorprep(R) label notes: "DO NOT USE FOR LUMBAR PUNCTURE OR IN CONTACT WITH THE MENINGES" (attached)
Authors of the British Royal College of Anaesthetists 3rd National Audit Project provided some guidance for the use of chlorhexidine for spinal procedures
Further: Correspondance from the Journal of Regional Anesthesia and Pain Medicine
"Dr. David Hepner published a correspondence in the April 2007 issue of Anesthesiology that stated the expert panel for Regional Anesthesia and Pain Medicine “felt strongly that although the US Food and Drug Administration has not approved chlorhexidine before lumbar puncture, it has a significant advantage over povidone iodine because of its onset, efficacy, and potency” and commented that “interestingly, povidone iodine is also not approved for lumbar puncture."
Chlorhexidine off-label use is supported in academic literature. Due to specific labeling prohibiting use, a formal institutional policy to support such use may be indicated.
Cook TM, Fischer B, Bogod D, et. al. Antiseptic solutions for central neuraxial blockade: which concentration of chlorhexidine in alcohol should we use? British Journal of Anaesthesia.2009. 103(3):456-457