Monday, 29 July 2013

Pregnancy- Epidurals and MS

Lu E, Zhao Y, Dahlgren L, Preston R, van der Kop M, Synnes A, Sadovnick AD, Traboulsee A, Tremlett H. Obstetrical epidural and spinal anesthesia in multiple sclerosis. J Neurol. 2013  [Epub ahead of print]
To examine obstetrical epidural and spinal anesthesia use in women with multiple sclerosis (MS) and the relationship with MS clinical factors. This was a retrospective (Already done and looking through the records) cohort study, linking clinical data from women with MS in the British Columbia (BC) MS database to obstetrical data (1998-2009) from the BC Perinatal Database Registry. We compared epidural use in 431 deliveries to women with MS and 2,959 deliveries from the general population, as well as spinal use in cesarean deliveries (128 to women with MS and 846 in the general population). We also examined the association between epidural or spinal anesthesia and MS clinical factors-disease duration and disability [Expanded Disability Status Scale (EDSS) score]. Of 431 deliveries to women with MS, 116 were exposed to epidural anesthesia and of 128 cesarean deliveries, 82 were exposed to spinal anesthesia. The use of epidural anesthesia was similar in nullipara (adjusted OR = 0.86, 95 % CI = 0.63-1.18, p = 0.36), but more likely in multipara with MS (adjusted OR = 1.75, 95 % CI = 1.20-2.54, p = 0.004). Spinal anesthesia use in cesarean deliveries was comparable between the MS and general population cohorts (adjusted OR = 0.84, 95 % CI = 0.55-1.31, p = 0.45). Women who delivered 5 to <10 years after MS onset were less likely to have an epidural (adjusted OR = 0.57, 95 % CI = 0.34-0.95, p = 0.03) vs. those delivering within 5 years. EDSS was not associated with use of either type of anesthesia (adjusted p > 0.1). Contrary to previous studies, epidural anesthesia use differed between women with MS and the general population and was influenced by parity and MS disease duration.
Come on Dr. Helen (blog reader) you know this is the stuff that women MSers of child bearing age may like to know so start writing these abstracts in Ingrish/Canadian:-) 

Epidural anaesthesia. The epidural route is frequently employed to administer analgesic and local anaesthetic agents through a catheter placed into the epidural space.Spinal anaesthesia is a technique whereby a local anaesthetic drug is injected into the cerebrospinal fluid. This technique has some similarity to epidural anaesthesia important differences include:
  • To achieve epidural analgesia, a larger dose of drug is typically necessary than with spinal analgesia.
  • The onset of analgesia is slower with epidural analgesia than with spinal analgesia.
  • An epidural injection may be performed anywhere along the vertebral column (cervical, thoracic, lumbar, or sacral), while spinal injections are typically performed below the second lumbar vertebral body to avoid piercing and consequently damaging the spinal cord.
  • It is easier to achieve segmental analgesia or anaesthesia using the epidural route than using the spinal route.
  • An indwelling catheter is more commonly placed in the setting of epidural analgesia or anaesthesia than with spinal analgesia or anaesthesia.
Nullipara is a woman who has never given birth is not someone from the parachute regiment, multipara is a woman who has had two or more pregnancies not loads of paratroopers. In those having multiple births you are more likely to use epidurals than non MSers. In you were older you less likely use epidurals.

What does this mean..to me not a lot as it is not my thing, but it says whatever your choice..pain or no pain, you are not alone. Maybe MSers are more accepting of using drugs as a person who gets back pain...why suffer when you don't need to. However this study does not say negative stuff about pregnancy and this is important to know.

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