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MULTIPLE SCLEROSIS(MS) AND PERIOPERATIVE NERVE BLOCKADE - SYSTEMATIC REVIEW
Author(s): ,
kuppuswamy mohanraj, A.*
Affiliations:
North West and North Wales Paediatric Transport Service Faculty of Life Sciences, Anaesthesia, Warrington, United Kingdom
Nalla Pillai, A.
Affiliations:
, Wigan, United Kingdom
ESRA Academy. K Mohanraj A. Sep 13, 2017; 190933; 408 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Arun K Mohanraj
Dr. Arun K Mohanraj

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Abstract
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Background and Aims:

Multiple sclerosis (MS) is one of the common chronic, immune mediated demyelinating disorders with a preponderance towards female population.Here we made an attempt to analyse the literature to create a systematic review with regards to nerve blockade(central and peripheral) and its effects in patients with MS.




Methods:

Search for randomised controlled trials (RCTs) and case-series studies were carried out using MEDLINE, EMBASE and cochrane CENTRAL trials register. RefWorks system was used to de-duplicate the studies collected.

Results:

Eight RCTs were found of which 5 were decided to be of inadequate strength to analyse further and there were no strong case series reports found to be added to the study. Mentionable findings from the study were

1. With regards to central neuraxial blockades(NAB) low dose epidural is considered safer as compared to spinal anaesthesia(Bajaj et al). Spinal anaesthesia is considered to be a relative contra-indication(Cimenti et al.).
2. Lumbar plexus blocks and para-vertebral blocks were noted to have prolonged duration in patients with MS.
3. Peripheral nerve blocks were found to be relatively safer as compared to central NABs(Schneider 2005). 

Conclusions:

1. Despite strong evidence spinal is better avoided. Low dose epidurals are relatively safer in such situations which warrant central NABs.
2. It should be borne in mind that some plexus blocks such as the para-vertebral can have prolonged duration in patients with MS.
3. PNBs are relatively safer though the anaesthetist should keep in mind that 5% of patients with MS will have peripheral nerve involvement. In all cases detailed discussion and meticulous documentation should be present. 

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