Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Abstract

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Total Hip Arthroplasty in Multiple Sclerosis

“…This could also be transferred to MS patients with THA under general anesthesia. From the field of obstetrics, there is evidence that regional and spinal anaesthesia can be used as successfully as general anaesthesia in existing MS without increasing the risk of postoperative worsening of MS symptoms [23,24]. Since the local anaesthetics used in regional and spinal anaesthesia forms share physiological properties such as the antiexcitatory effect with the pentapeptides that are increased in cerebrospinal fluid in MS, the occurrence of MS symptoms, especially in spinal anaesthesia, is theoretically possible [25].…”

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

“…The emergence of more extensive prospective studies leads to more favourable results and an increased exposure to local analgesia/anaesthesia. 7,60,[70][71][72] Except for one study, it is unclear whether women received locoregional analgesia or anaesthesia. There is no increased risk of relapse in the PP associated with local analgesia/anaesthesia.…”

Is neuraxial anesthesia not associated with increased risk of post-partum relapses in multiple sclerosis? More precise assessment is required

“…We read with great interest the article by Lavie et al 1 that aimed to assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum. This question is of importance because some anesthesiologists are still reluctant to perform regional anesthesia in women with multiple sclerosis, fearing it might trigger post-partum relapses when administering local anesthetics close to demyelinated fibers.…”

“…Hence, the generic term “neuraxial analgesia” corresponds to various situations as regards the site of administration, the concentration of local anesthetics, the total dose administered, and the spread of local anesthetic into the epidural space. If it can be admitted that epidural analgesia is not associated with increased risk of post-partum relapses, 1,4 the question remains as to the risk associated with epidural or spinal anesthesia, especially in case of recent or active relapse. This question should be addressed in prospective studies with precise assessment of the anesthetic technique performed.…”