Effect of neuraxial anaesthesia or analgesia on postpartum relapse rates in multiple sclerosis: A systematic review.

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2025-06-01 Epub Date: 2025-02-27 DOI:10.1097/EJA.0000000000002155
Dimitrios Ioannopoulos, Kleanthi Manika, Panagis M Lykoudis, Marianna Papadopoulou, Eleftheria Lelekaki, Zoi Tsani, Pinelopi Kouki
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引用次数: 0

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease affecting primarily women of childbearing age. Recent advancements in treatment have led to more women with MS pursuing motherhood. Despite much new evidence on the safety of neuraxial anaesthesia/analgesia, many anaesthetists are still reluctant to provide neuraxial anaesthesia/analgesia to these patients.

Objective: The present systematic review aimed to evaluate the safety of administrating neuraxial anaesthesia/analgesia to parturients with MS.

Outcome: The incidence of MS relapses occurring up to 1 year after childbirth was the main outcome of interest.

Design: A systematic review of randomised and non-randomised controlled trials.

Data sources: MEDLINE (PubMed), Library of Congress and LiSTA (EBSCO) were searched to identify eligible trials.

Eligibility criteria: Randomised or nonrandomised prospective studies and retrospective comparative studies, comparing MS relapses following caesarean section or vaginal delivery were included.

Results: Eight studies involving 1315 parturients were included. There was no statistically significant difference in the incidence of postpartum relapses between women who received neuraxial anaesthesia/analgesia and those who did not ( P  > 0.05). A statistically significant increase in the probability of a relapse was consistently observed across the majority of studies in women who had experienced relapses during pregnancy or during the year preceding the pregnancy ( P  < 0.05).

Conclusion: Neuraxial analgesia/anaesthesia does not increase the risk of postpartum relapse in MS parturients in the year following delivery. The risk of postpartum relapse is related to symptom exacerbation during the year before pregnancy or during pregnancy. Adequately powered, prospective, studies are strongly recommended to confirm the above results.

神经轴向麻醉或镇痛对多发性硬化症产后复发率的影响:一项系统综述。
背景:多发性硬化症(MS)是一种主要影响育龄妇女的慢性自身免疫性疾病。最近在治疗方面的进步使得更多的多发性硬化症女性寻求成为母亲。尽管有许多新的证据表明轴向麻醉/镇痛的安全性,但许多麻醉师仍然不愿意为这些患者提供轴向麻醉/镇痛。目的:本系统综述旨在评估多发性硬化症(MS)患者给予轴向麻醉/镇痛的安全性。结果:分娩后1年内多发性硬化症复发的发生率是主要的研究结果。设计:对随机和非随机对照试验进行系统评价。数据来源:检索MEDLINE (PubMed)、国会图书馆和LiSTA (EBSCO)以确定符合条件的试验。入选标准:纳入随机或非随机前瞻性研究和回顾性比较研究,比较剖宫产或阴道分娩后MS复发情况。结果:纳入8项研究,共1315例产妇。经轴向麻醉/镇痛组与未经轴向麻醉/镇痛组产后复发发生率比较,差异无统计学意义(P < 0.05)。在大多数研究中,在怀孕期间或怀孕前一年经历复发的妇女中,一致观察到复发概率的统计学显著增加(P结论:轴向镇痛/麻醉不会增加分娩后一年MS产妇产后复发的风险。产后复发的风险与孕前一年或孕期症状加重有关。强烈建议进行充分有力的前瞻性研究来证实上述结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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