Background and Aims Regional anesthesia use has historically been categorized as relative contraindication among patients with certain preexistent neurological disorders (1–3). It is unclear if the fear of developing new or worsening symptoms among this group is driving anesthesiologists to prefer or avoid a specific type of anesthesia technique. We sought to determine if neuraxial anesthesia use during TKA/THA differed among those previously diagnosed with multiple sclerosis or myasthenia gravis in comparison to the population without the diseases.
Methods This study is approved by Hospital for Special Surgery Institutional Review Board (IRB# 2016–436). We analyzed patients undergoing a TKA/THA procedure using the Premier Healthcare Database. We created individual multivariable logistic regression models to compare patients with multiple sclerosis or myasthenia gravis to the non-diagnosed population.
Results We identified 2,184,193 patients undergoing a TKA/THA procedure, with 7,559 having a preoperative diagnosis for multiple sclerosis and 3,176 for myasthenia gravis. Neuraxial use among patients with pre-existing multiple sclerosis was lower (OR: 0.62, p=<.0001) than the non-diagnosed population (Table 1). Neuraxial anesthesia use among patients with pre-existing myasthenia gravis was not significantly different than use among the non-diagnosed population (OR: 1.05, p=0.2359).
Conclusions Neuraxial anesthesia use during a TKA/THA procedure among those with pre-existing multiple sclerosis was significantly lower than those without the disease while about the same as controls for myasthenia gravis, respectively. Although previous research indicates that there is no relationship between neuraxial use and the exacerbation of symptoms in those with multiple sclerosis, there is indication that anesthesiologists are more likely to use general anesthesia.
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