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

Lavie, C.; Rollot, F.; Durand-Dubief, F.; Marignier, R.; Ionescu, I.; Casey, R.; Moreau, T.; Tourniaire, P.; Hutchinson, M.; D'Hooghe, M. B.; Laplaud, D. -A.; Clavelou, P.; De Seze, J.; Debouverie, M.; Brassat, D.; Pelletier, J.; Lebrun-Frenay, C.; Le Page, E.; Castelnovo, G.; Berger, E.; Hautecoeur, P.; Heinzlef, O.; Durelli, L.; Clerico, M.; Trojano, M.; Patti, F.; Vukusic, S.; Alperovitch, A.; Carton, H.; Hommes, O.; Adeleine, P.; Biron, A.; Cortinovis-Tourniaire, P.; Grimaud, J.; Hours, M.; Confavreux, C.; Chauplannaz, G.; Latombe, D.; Clanet, M.; Lau, G.; Rumbach, L.; Goas, J. Y.; Rouhart, F.; Mazingue, A.; Roullet, E.; Madigand, M.; Brunet, P.; Edan, G.; Allaire, C.; Riffault, G.; Leche, J.; Benoit, T.; Simonin, C.; Ziegler, F.; Baron, J. C.; Rivrain, Y.; Dumas, R.; Loche, D.; Bourrin, J. C.; Huttin, B.; Delisse, B.; Gibert, I.; Boulay, C.; Verceletto, M.; Durand, G.; Bonneviot, G.; Gil, R.; Hedreville, M. A.; Belair, C.; Poitevin, R. J.; Devoize, J. L.; Wyremblewski, P.; Delestre, F.; Setiey, A.; Comi, G.; Filippi, M.; Ghezzi, A.; Martinelli, V.; Rossi, P.; Zaffaroni, M.; Tola, M. R.; Amato, M. P.; Fioretti, C.; Meucci, G.; Inglese, M.; Mancardi, G. L.; Gambi, D.; Thomas, A.; Cavazzuti, M.; Citterio, A.; Heltberg, A.; Hansen, H. J.; Fernandez, O.; Romero, F.; Arbizu, T.; Hernandez, J. J.; De Andres de Frutos, C.; Geffner Sclarky, D.; Aladro Benito, Y.; Reyes Yanes, P.; Aguilar, M.; Burguera, J. A.; Yaya, R.; Bonakim Dib, W.; Arzua-Mouronte, D.; Sindic, C. J. M.; Medaer, R.; Roose, H.; Geens, K. M. J.; Guillaume, D.; Van Zandycke, M.; Janssens, J.; Cornette, M.; Mol, L.; Weilbach, F.; Flachenecker, P.; Hartung, H. P.; Haas, J.; Tendolkar, I.; Sindrn, E.; Kolmel, H. W.; Reichel, D.; Rauch, M.; Preuss, S.; Poser, S.; Mauch, E.; Strausser-Fuchs, S.; Kolleger, H.; Hawkins, S.; Howell, S. J. L.; Rees, J. E.; Thompson, A.; Johnson, M.; Boggild, M.; Gregory, R. P.; Bates, D.; Bone, I.; Polman, C.; Frequin, S.; Jongen, P.; Correia de Sa, J.; Rio, M. E.; Huber, S.; Lechner-Scott, J.; Kappos, L.; Cornu, C.; El-Etr, M.; Baulieu, E. E.; Schumacher, M.; Miller, D. H.; Pugeat, M.; D'Archangues, C.; Conard, J.; Menard, J.; Sitruk-Ware, R.; Pelissier, C.; Dat, S.; Belaisch-Allard, J.; Athea, N.; Buschsenschutz, D.; Lyon-Caen, O.; Gonsette, R.; Boissel, J. P.; Ffrench, P.; Cotton, F.; Pachai, C.; Bracoud, L.; Androdias, G.; Wiertlewski, S.; Lanctin-Garcia, C.; Couvreur, G.; Madinier, G.; Taithe, F.; Aufauvre, D.; Guy, N.; Ferrier, A.; Collongues, N.; Viala, F.; Gerdelat-Mas, A.; Henry, P.; Rico-Lamy, A.; Lepage, E.; Deburghraeve, V.; Blondiau, M.; Coustans, M.; Clerc, C.; Rieu, L.; Lauxerois, M.; Hinzelin, G.; Ouallet, J. C.; Minier, D.; Vion, P.; Gromaire-Fayolle, N.; Derache, N.; Thouvenot, E.; Sallansonnet-Froment, M.; Toureille, L.; Borgel, F.; Stankoff, B.; Moroianu, C.; Guennoc, A. M.; Tournier-Gervason, C. L.; Peysson, S.; D'Amico, E.; Motti, L.; Tavella, A.

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 postpartum 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.