Neuraxial Analgesia Is Not Associated With An Increased Risk Of Post-Partum Relapses In Ms
Caroline Lavie,Fabien Rollot,Francoise Durand-Dubief,Romain Marignier,Iuliana Ionescu,Romain Casey,Thibault Moreau,Patricia Tourniaire,Michael Hutchinson,Marie Beatrice D'Hooghe,David-Axel Laplaud,Pierre Clavelou,Jerome De Seze,Marc Debouverie,David Brassat,Jean Pelletier,Christine Lebrun-Frenay,Emmanuelle Le Page,Giovanni Castelnovo,Eric Berger,Patrick Hautecoeur,Olivier Heinzlef,Luca Durelli,Marinella Clerico,Maria Trojano,Francesco Patti,Sandra Vukusic,A. Alperovitch,H. Carton,M. B. D'Hooghe,O. Hommes,M. Hutchinson,P. Adeleine,A. Biron,P. Cortinovis-Tourniaire,J. Grimaud,M. Hours,T. Moreau,S. Vukusic,C. Confavreux,G. Chauplannaz,C. Confavreux,P. Cortinovis-Tourniaire,J. Grimaud,D. Latombe,T. Moreau,M. Clanet,G. Lau,L. Rumbach,J. Y. Goas,F. Rouhart,A. Mazingue,E. Roullet,M. Madigand,P. Hautecoeur,P. Brunet,G. Edan,C. Allaire,J. Leche,T. Benoit,C. Simonin,F. Ziegler,J. C. Baron,Y. Rivrain,R. Dumas,D. Loche,J. C. Bourrin,B. Huttin,B. Delisse,I. Gibert,C. Boulay,M. Verceletto,G. Durand,G. Bonneviot,R. Gil,M. A. Hedreville,C. Belair,R. J. Poitevin,J. L. Devoize,P. Wyremblewski,F. Delestre,A. Setiey,G. Comi,M. Filippi,A. Ghezzi,V. Martinelli,P. Rossi,M. Zaffaroni,M. R. Tola,M. P. Amato,C. Fioretti,G. Meucci,M. Inglese,G. L. Mancardi,D. Gambi,A. Thomas,M. Cavazzuti,A. Citterio,A. Heltberg,H. J. Hansen,O. Fernandez,F. Romero,T. Arbizu,J. J. Hernandez,C. De Andres De Frutos,D. Geffner Sclarky,Y. Aladro Benito,P. Reyes Yanes,M. Aguilar,J. A. Burguera,R. Yaya,W. Bonakim Dib,D. Arzua-Mouronte,M. B. D'Hooghe,C. J. M. Sindic,H. Carton,R. Medaer,H. Roose,K. M. J. Geens,D. Guillaume,M. Van Zandycke,J. Janssens,M. Cornette,L. Mol,F. Weilbach,P. Flachenecker,H. P. Hartung,J. Haas,I. Tendolkar,E. Sindrn,H. W. Kolmel,D. Reichel,M. Rauch,S. Preuss,S. Poser,E. Mauch,S. Strausser-Fuchs,H. Kolleger,S. Hawkins,S. J. L. Howell,J. E. Rees,A. Thompson,M. Johnson,M. Boggild,R. P. Gregory,D. Bates,I. Bone,M. Hutchinson,C. Polman,S. Frequin,P. Jongen,O. Hommes,J. Correia De Sa,M. E. Rio,S. Huber,J. Lechner-Scott,L. Kappos,I. Ionescu,C. Cornu,C. Confavreux,S. Vukusic,M. El-Etr,E. E. Baulieu,M. El-Etr,M. Schumacher,I. Ionescu,C. Confavreux,C. Cornu,S. Vukusic,H. P. Hartung,D. H. Miller,M. Hutchinson,M. Pugeat,C. D'Archangues,J. Conard,J. Menard,R. Sitruk-Ware,C. Pelissier,S. Dat,J. Belaisch-Allard,N. Athea,D. Buschsenschutz,O. Lyon-Caen,R. Gonsette,J. P. Boissel,P. Ffrench,F. Durand-Dubief,F. Cotton,C. Pachai,L. Bracoud,S. Vukusic,I. Ionescu,G. Androdias,R. Marignier,G. Chauplannaz,D. A. Laplaud,S. Wiertlewski,C. Lanctin-Garcia,T. Moreau,G. Couvreur,G. Madinier,P. Clavelou,F. Taithe,D. Aufauvre,N. Guy,A. Ferrier,J. De Seze,N. Collongues,M. Debouverie,F. Viala,D. Brassat,A. Gerdelat-Mas,P. Henry,J. Pelletier,A. Rico-Lamy,C. Lebrun-Frenay,E. Lepage,V. Deburghraeve,G. Edan,G. Castelnovo,E. Berger,P. Hautecoeur,M. Blondiau,O. Heinzlef,M. Coustans,C. Clerc,L. Rieu,M. Lauxerois,G. Hinzelin,J. C. Ouallet,D. Minier,P. Vion,N. Gromaire-Fayolle,N. Derache,E. Thouvenot,M. Sallansonnet-Froment,P. Tourniaire,L. Toureille,F. Borgel,B. Stankoff,J. Grimaud,C. Moroianu,A. M. Guennoc,C. L. Tournier-Gervason,S. Peysson,M. Trojano,F. Patti,E. D'Amico,L. Motti,M. Zaffaroni,L. Durelli,A. Tavella
MULTIPLE SCLEROSIS JOURNAL（2019）
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摘要
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.
