Effect of Neuraxial Anesthesia or Analgesia on Postpartum Relapse Rates in Multiple Sclerosis: A Systematic Review

Eur J Anaesthesiol . 2025 Jun 1;42(6):508–517. doi: 10.1097/EJA.0000000000002155. Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS) and is estimated to affect 35.9 per 100,000 people globally. The prevalence of MS among adults at their most productive age of life has a significant impact on family, financial, and career goals; MS is 3 times more frequently diagnosed in women, with the typical age at diagnosis being between 20 and 30. The misconception that pregnancy could worsen MS symptoms has prevented many individuals with MS from becoming pregnant, though disease-modifying therapies (DMTs) developed recently have enabled more women to feel confident pursuing it. Though pregnancy itself is not an independent risk factor for the worsening of MS, there are risks during pregnancy that are associated with MS. This presents a challenge for clinicians and anesthesiologists as well in terms of optimizing patient safety and delivering adequate care. In the past, there have been additional concerns about the effects of local anesthetics in patients with MS, though there is no comprehensive evidence or clinical recommendations surrounding their use in this population. This study is a systematic review aimed at compiling evidence surrounding the use of anesthetic techniques in patients with MS and providing recommendations for technique selection.