Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS
Authors: Lavie Caroline , Rollot Fabien , Durand-Dubief Françoise , Marignier Romain , Ionescu Iuliana , Casey Romain , Moreau Thibault , Tourniaire Patricia , Hutchinson Michael , D’Hooghe Marie Béatrice , Laplaud David-Axel , Clavelou Pierre , De Sèze Jérôme , Debouverie Marc , Brassat David , Pelletier Jean , Lebrun-Frenay Christine , Le Page Emmanuelle , Castelnovo Giovanni , Berger Eric , Hautecoeur Patrick , Heinzlef Olivier , Durelli Luca , Clerico Marinella , Trojano Maria , Patti Francesco , Vukusic Sandra , Alpérovitch A. , Carton H. , d’Hooghe M.B. , Hommes O. , Hutchinson M. , Adeleine P. , Biron A. , Cortinovis-Tourniaire P. , Grimaud J. , Hours M. , Moreau T. , Vukusic S. , Confavreux C. , Chauplannaz G. , Confavreux C. , Cortinovis-Tourniaire P. , Grimaud J. , Latombe D. , Moreau T. , Clanet M. , Lau G. , Rumbach L. , Goas J.Y. , Rouhart F. , Mazingue A. , Roullet E. , Madigand M. , Hautecoeur P. , 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. , d’Hooghe M.B. , Sindic C.J.M. , Carton H. , 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. , Kölmel 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. , Hutchinson M. , Polman C. , Frequin S. , Jongen P. , Hommes O. , Correia de Sa J. , Rio M.E. , Huber S. , Lechner-Scott J. , Kappos L. , Ionescu I. , Cornu C. , Confavreux C. , Vukusic S. , El-Etr M. , Baulieu E.E. , El-Etr M. , Schumacher M , Ionescu I. , Confavreux C. , Cornu C. , Vukusic S. , Hartung H.P. , Miller D.H. , Hutchinson M. , Pugeat M. , d’Archangues C. , Conard J. , Ménard J. , Sitruk-Ware R. , Pelissier C. , Dat S. , Belaïsch-Allard J. , Athéa N. , Büschsenschutz D. , Lyon-Caen O. , Gonsette R. , Boissel J.P. , Ffrench P. , Durand-Dubief F. , Cotton F. , Pachai C. , Bracoud L. , Vukusic S. , Ionescu I. , Androdias G. , Marignier R. , Chauplannaz G. , Laplaud D.A. , Wiertlewski S. , Lanctin-Garcia C. , Moreau T. , Couvreur G. , Madinier G. , Clavelou P. , Taithe F. , Aufauvre D. , Guy N. , Ferrier A. , De Sèze J. , Collongues N. , Debouverie M. , Viala F. , Brassat D. , Gerdelat-Mas A. , Henry P. , Pelletier J. , Rico-Lamy A. , Lebrun-Frenay C. , Lepage E. , Deburghraeve V. , Edan G. , Castelnovo G. , Berger E. , Hautecoeur P. , Blondiau M. , Heinzlef O. , 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. , Tourniaire P. , Toureille L. , Borgel F. , Stankoff B. , Grimaud J. , Moroianu C. , Guennoc A.M. , Tournier-Gervason C.L. , Peysson S. , Trojano M. , Patti F. , D’Amico E. , Motti L. , Zaffaroni M. , Durelli L. , Tavella A. 
Published: March 2018

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.