neuroaxial anesthesia and Multiple sclerosis

Although regional central conduction blockade, and especially spinal anesthesia, has been implicated in the exacerbation of MS , the studies are very small.

Local anesthetic neurotoxicity has been speculated as being a more likely in nerves which are demyelinated, i.e. in MS patients.

As such, theoretically epidural anesthesia may be less of a risk as concentrations of local anesthetic in the white matter of the spinal cord are lower than with spinal anesthesia

Overall, however, the use of epidural anesthesia appears safe. Bader et al. noted that in women who received epidural anesthesia for vaginal delivery, relapse rates were similar to those who received local infiltration. Additional prospective and randomized studies will need to be conducted to evaluate the true relationship between regional anesthesia and MS exacerbations.