Anesthesia for the obstetric patient with multiple sclerosis

Multiple sclerosis and pregnancy

“…An increased rate of relapse was found in patients given concentrations of bupivacaine greater than 0.25%, although no difference was reported between patients having local versus epidural blockade. 25 However, the relapse rate (33%) reported by Bamford et al was of the same order as that seen overall in patients postpartum and as such it is difficult to speculate about causality. 24 The PRIMS group found no association between epidural anaesthesia and relapse rate.…”

Anesthésie neuraxiale et sclérose en plaques

“…10 Dans d'autres séries on n'a pas décrit la qualité ou la durée de l'anesthésie. 11,12 Dans le présent numéro du Journal canadien d'anesthésie, Finucane et coll. présentent un cas inhabituel de rachianesthésie accidentelle présumée à la suite d'un bloc paravertébral lombaire à deux niveaux chez une femme de 33 ans jugée en bonne santé au moment de l'intervention chirurgicale, mais chez qui on a diagnostiqué une SP par la suite.…”

“…10 Other case series did not describe the quality or duration of anesthesia. 11,12 In the current issue of the Canadian Journal of Anesthesia, Finucane et al report an unusual case of presumed unintentional spinal anesthetic following a two-level lumbar paravertebral block in a 33-yr-old lady who was deemed healthy at the time of surgery but was later found to have MS. 13 Extensive sensory and motor blockade from T4 to sacrum bilaterally following the administration of bupivacaine 60 mg, made the authors suspicious of unintentional intrathecal administration. Block regression was prolonged; the level regressed to T12 six and a half hours later, and completely resolved sometime between six and a half and 11 hr post-injection.…”

“…The rate of relapse within three months was comparable in the three groups, and was similar to the one previously reported for women with MS in the first few months post-partum. 11 Also, the scattered timing of those relapses made the author suggest that factors other than the anesthetic technique should be considered. More recently, from a series of 19 obstetric patients, Dalmas et al suggest that epidural anesthesia is innocuous in this context.…”

Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block

“…Local anesthetics have been implicated as a possible cause of exacerbation of MS in patients undergoing central neural blockade. Bader et al 8 reported on a combined prospective/retrospective study of MS in obstetric patients receiving epidural anesthesia and local anesthesia infiltration for vaginal delivery at the Brigham and Women's Hospital between 1982 and 1987. They noted that all patients who experienced an exacerbation of MS had received epidural anesthesia with bupivacaine concentrations greater than 0.25%.…”