Background and Aims Multiple sclerosis (MS) is a relapsing and remitting disease that may include symptoms of sensory or motor deficits, optic neuritis, bowel or bladder dysfunction, ataxia. Epidural administration of LA for cesarean delivery has historically been thought to be less risky for patients with MS than a spinal technique.
This report related to the use of low dose combined spinal epidural anesthesia and epidural volume extension for cesarean section in two pregnant with multiple sclerosis
Methods Two pregnant, 34 and 38 years old, are scheduled for an elective cesarean section for obstetric reasons. After informal consent and the same characteristics of gestation without complication, asymptomatic disease of MS for years and standard monitoring, combined spinal epidural technique was performed with the women in sitting position, level L3-L4, with intrathecal administration of 1,6 ml Levobupivacaine 0,5% + fentanyl 20γ and placed epidural catheter.
Results After 10 minutes the sensitive block was achieved at T8 level. 5 ml of epidural saline was administrated and 5 minutes later the sensitive block was at T6. The women remained with stable blood pressure and cardiac rhythm with low dose of neosynephrine. The cesarean sections developed without complications. Into the Recovery Room the patients had Grade II motor blockade (Bromage scale) without complications.
Conclusions A small dose of spinal Levobupivacaine can induce adequate analgesic levels with lower incidence of hypotension and motor block (in relation to sensitive) and the epidural injection of saline afterwards stabilize the safety and duration of analgesia to these patients, offers advantages over alternative techniques.