Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Multiple sclerosis (MS) is a common chronic, immune mediated demyelinating disorders with a preponderance towards the 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 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, five were decided to be of inadequate strength to analyse further. We also found no strong case series reports to be added to the study. Regarding Central Neuraxial Blocks (CNBs), 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). Furthermore, Lumbar plexus blocks and para-vertebral blocks were noted to have prolonged duration in patients with MS while Peripheral Nerve Blocks (PNBs) is thought to be relatively safer as compared to CNB (Schneider 2005).

Conclusions Despite compelling evidence suggesting that spinal anaesthesia should be avoided in certain situations, low-dose epidurals present a relatively safer alternative when CNBs are necessary. It is important to consider that some plexus blocks, like the paravertebral block, may have a prolonged duration in patients with MS. PNBs are generally safer, although the anaesthetist must be aware that approximately 5% of patients with MS may have peripheral nerve involvement. In all cases, a thorough discussion with the patient and meticulous documentation are essential.