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Multiple Sclerosis and Neuraxial Block — FRCA Final MCQ

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ModerateRegional AnaesthesiaMultiple Sclerosis and Neuraxial BlockFRCA Final

A 50-year-old woman (ASA II) with a history of multiple sclerosis is scheduled for knee arthroscopy. She is currently in remission with stable neurological function. What is the specific concern regarding neuraxial anaesthesia in multiple sclerosis?

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Correct answer: D — Theoretical risk of exacerbating disease by exposing demyelinated nerves to local anaesthetic

Multiple sclerosis is a relative (not absolute) contraindication to neuraxial anaesthesia. The theoretical concern is that demyelinated spinal cord neurons may be more susceptible to neurotoxicity from local anaesthetics. Spinal anaesthesia exposes the cord to higher concentrations than epidural anaesthesia. Current consensus: epidural is preferred over spinal (lower cord exposure), the lowest effective concentration should be used, and the decision should be individualised with informed patient consent documenting pre-existing neurological deficits. General anaesthesia is also safe.

Reference: RCOA – 2023 – Regional anaesthesia in neurological disease; Association of Anaesthetists – 2020 – Neurological conditions