Ann Fr Anesth Reanim. 2003 Dec;22(10):861-4
Dalmas AF, Texier C, Ducloy-Bouthors AS, Krivosic-Horber R.
Departement d'anesthesie et de reanimation chirurgicale I, maternite Jeanne-de-Flandre, CHRU de Lille, 59037 cedex, Lille, France
The use of epidural analgesia and anaesthesia is controversial in patients with multiple sclerosis (MS) due to the potential neurotoxicity of local anaesthetics.
The aim of this study was to evaluate the place and the safety of epidural obstetrical analgesia in these patients.
Patients and methods.
A consecutive series of 19 patients with MS was studied over 4 years, recording the type of anaesthesia and the obstetric and neurologic observations during the pregnancy and post-partum.
Ten patients had epidural analgesia.
One patient had a caesarean section under epidural anaesthesia.
Five patients relapsed during the post-partum period.
Only one of them had an epidural for a spontaneous vaginal delivery, without any evidence of a causal relationship.
Spinal anaesthesia is generally not advocated in the presence of MS due to concerns relating to the stronger local anaesthetics required and was therefore not used.
The results confirm that epidural analgesia is innocuous in this context.
The important points are the precise evaluation of the existing neurological symptoms and the sparing of local anaesthetics thanks to the addition of opioids.