Spinal anesthesia in the parturient with multiple sclerosis : case discussion and literature review

A 30-year old female patient with a history of relapsing-remitting multiple sclerosis (MS) was planned for an elective cesarean section. Additionally, the patient suffered from Generalized Anxiety Disorder. After careful discussion with the patient, spinal anesthesia was chosen for the procedure. The anesthetic course was uneventful and cesarean section was without incident. No per-or post-operative complications were observed. No relapse or disease aggravation occurred in the first three months following delivery. Subsequently, a more profound MEDLINE and EMBASE literature search was conducted to review current evidence regarding safety of neuraxial anesthesia, and more specifically spinal anesthesia, in patients with MS. Neuraxial anesthesia has historically always faced considerable skepticism in this population. Current consensus, however, postulates no contra-indication for the use of neuraxial anesthesia in patients with MS. Epidural anesthesia remains the conventional neuraxial technique for purely paradigmatic reasons. A number of cases may nowadays safely benefit from a spinal technique.