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

• Published in: Multiple sclerosis Vol. 25; no. 4; pp. 591 - 600
• Main Authors: Lavie, Caroline, Rollot, Fabien, Ionescu, Iuliana, Casey, Romain, Moreau, Thibault, Tourniaire, Patricia, D’Hooghe, Marie Béatrice, Laplaud, David-Axel, Clavelou, Pierre, De Sèze, Jérôme, Pelletier, Jean, Lebrun-Frenay, Christine, Castelnovo, Giovanni, Heinzlef, Olivier, Durelli, Luca, d’Hooghe, M.B., Hutchinson, M., Adeleine, P., Biron, A., Grimaud, J., Hours, M., Moreau, T., Confavreux, C., Chauplannaz, G., Goas, J.Y., Rouhart, F., Mazingue, A., Roullet, E., Benoit, T., Simonin, C., Dumas, R., Loche, D., Bourrin, J.C., Boulay, C., Belair, C., Devoize, J.L., Setiey, A., Comi, G., Filippi, M., Fioretti, C., Meucci, G., Gambi, D., Cavazzuti, M., Hansen, H.J., Fernandez, O., Geffner Sclarky, D., Reyes Yanes, P., Aguilar, M, Arzua-Mouronte, D., Medaer, R., Guillaume, D., Van Zandycke, M., Janssens, J., Cornette, M., Mol, L., Weilbach, F., Flachenecker, P., Strausser-Fuchs, S., Hawkins, S., Howell, S.J.L., Rees, J.E., Boggild, M., Bates, D., Jongen, P., Rio, M.E., Lechner-Scott, J., Kappos, L., Baulieu, E.E., Miller, D.H., Ménard, J., Sitruk-Ware, R., Pelissier, C., Dat, S., Athéa, N., Büschsenschutz, D., Lyon-Caen, O., Boissel, J.P., Ffrench, P., Cotton, F., Bracoud, L., Marignier, R., Laplaud, D.A., Lanctin-Garcia, C., Clavelou, P., Aufauvre, D., Brassat, D., Rico-Lamy, A., Deburghraeve, V., Castelnovo, G., Berger, E., Blondiau, M., Clerc, C., Ouallet, J.C., Minier, D., Thouvenot, E., Toureille, L., Peysson, S., Patti, F., D’Amico, E., Durelli, L.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2019; Sage Publications Ltd
• Subjects: 17β-Estradiol; Adult; Analgesia; Anesthesia, Conduction - adverse effects; Anesthetics; Data processing; Female; Follow-Up Studies; Human health and pathology; Humans; Life Sciences; Local anesthetics; Multiple sclerosis; Multiple Sclerosis - chemically induced; Multiple Sclerosis - physiopathology; Neurotoxicity; Pain perception; Postpartum Period; Pregnancy; Pregnancy Complications - chemically induced; Pregnancy Complications - physiopathology; Progestin; Recurrence; Retrospective Studies; Santé publique et épidémiologie; neuraxial analgesia; post-partum; Multiple sclerosis; relapses; pregnancy
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458518763080

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.