What Experts Want You to Know About MS and Anesthesia

The use of anesthesia in patients with multiple sclerosis (MS) has been controversial because some medical professionals believe that it may cause a relapse of MS symptoms. However, research has not proven that to be the case. In fact, many studies contradict that belief altogether.

Still, recovering from any surgery can present challenges for people with MS because of certain symptoms of the condition, especially muscle weakness, tremors, trouble walking, fatigue, and dizziness.

Read on to find out more about how surgery and anesthesia affect people with MS.

How Does Anesthesia Affect MS and Surgery?

Anesthesia is the use of medicines designed to halt or interrupt the signals that are sent by nerves in the brain and body while a person is undergoing surgery. There have been many claims that anesthesia can increase relapses in people with MS because of the way that it affects already damaged nerves. However, some studies have shown that anesthesia may instead interact with MS medications—not the damaged nerves themselves.

A review published in 2013 in Anesthesiology and Pain Medicine pulled information from case reports dating back to 1987. The results found that some people with MS did experience problems with anesthesia, but it depended on which type was used.

While the case reports did demonstrate that some people with MS who received anesthesia had some problems, it was not clear whether the problems were caused by MS or other factors. The review also suggested that MS medications could negatively interact with some anesthesia agents, which could induce or worsen certain MS symptoms such as muscle weakness.

More recent reports have not found a connection between anesthesia and MS, which is why the subject remains a controversial topic within the medical community.

Origin of Theories 

It's not clear when the belief that anesthesia could worsen symptoms started, but it may have been tied to the case reports published in 1987 that outlined the risks associated with anesthesia in patients with MS.

However, an even older case report that was published in 1978 concluded that there was no evidence to support the risk of relapse in people with MS who had undergone surgery with anesthesia.

Timeline of Medical Understanding

Prior to the 2000s, the studies on MS and anesthesia were largely contradictory. The case report in 1987 said that anesthesia could exacerbate (worsen) symptoms in people with MS, but another report that was published almost a decade earlier claimed the opposite. The conflicting reports contributed to the controversy within the medical community regarding MS and anesthesia.

Early 2000s

By the early 2000s, research on the effects of anesthesia and surgery on MS took a back seat in favor of searching for new treatment options. The main goal of research since then has been to find ways to safely perform surgery on patients with MS who might be more at risk for complications because of a high level of disability or respiratory symptoms.

A journal course for nurses that was published in 2005 concluded that because both anesthesia and MS can be unpredictable, understanding the characteristics of the disease is necessary to properly and safely perform surgery on patients with the condition.

The course also noted that anesthesia itself may not be the culprit behind worsened symptoms—rather, it could be surgery complications such as fever or infection.

Present Day

Today, medical researchers have debunked the theory that anesthesia leads to symptom relapse in people with MS. According to the National Multiple Sclerosis Society, there is no increased risk of relapse when someone with MS has surgery with anesthesia.

Further research has reinforced the conclusion of no additional risk of relapse since a connection still has not been made between the two. Other studies found no evidence of specific surgery complications in people with MS other than the weakness that can occur in anyone who is recovering from surgery.

A study in 2020 looked at 281 MS patients who had 609 surgeries. The researchers found that only 12 people had postoperative relapses. Most patients who relapsed were white, nonsmoking women. The patients also had lesions that were enhanced prior to surgery.

Of the 12 cases that presented with MS relapse, six experienced fever as a complication of the surgery. Fever has been shown to worsen the symptoms of MS.

Types of Anesthesia 

There are four types of anesthesia: general, regional, local, and conscious sedation.

• General anesthesia renders patients unconscious and into a sleep-like state. They are unaware of the procedure and will not remember anything about it when they wake up.
• Regional anesthesia uses medications that are injected into a nerve or collection of nerves to block sensations in a specific area of the body. Regional anesthesia is often used during childbirth in the form of an epidural.
• Local anesthesia is similar to regional anesthesia, as it is used in one specific area. It is often used in dentistry.
• Conscious sedation is used to reduce consciousness (rather than eliminate it altogether) in an effort to reduce discomfort and pain during a procedure.

People with MS who have surgery using general anesthesia might be more at risk for complications if they have a more advanced form of the disease. For example, a person with MS who is bedridden will likely have a harder recovery than someone whose disease has not progressed as far. People with MS and respiratory symptoms are also at a greater risk for complications following surgery.

MS and Anesthesia for Childbirth 

Research on MS and anesthesia during childbirth is limited. According to the National Multiple Sclerosis Society, there are no added risks involved. All types of anesthesia are considered safe to use during childbirth for people with MS.

However, the limited research available does claim that the type of anesthesia used might be a factor in determining safety. For example, epidural anesthesia is likely less risky than a spinal anesthetic because there is less of a chance of the medication getting into the cerebral spinal fluid, the clear fluid that surrounds the brain and spinal cord to act as a cushion in the event of an injury occurs.

The amount of medication is also a safety factor to consider for people with MS who are giving birth.

A 2017 study looked at women with MS who had epidurals during both vaginal deliveries and cesarean deliveries. The women who gave birth vaginally were shown to be more likely to have a symptom relapse after giving birth when higher concentrations of the specific anesthesia drugs Marcaine (bupivacaine) and lidocaine were used.

In the patients who underwent cesarean deliveries with an epidural, the risk of having at least one relapse in the following year was much higher. However, the patients that relapsed had worse disease progression than the people who did not. They also experienced more relapses prior to and during their pregnancies.   

Anesthesia for MS Surgery

In some cases, people with MS can undergo surgical procedures that may reduce their symptoms and improve their quality of life. Many studies have shown that it is unlikely that anesthesia causes MS relapses; therefore, undergoing surgery for MS symptoms is generally considered safe and effective.

The only risks involved—as with other types of surgery—center around a person’s level of disease progression and disability. A person's current state of health always plays an important role in their risk for surgery complications.

Overcoming Fear and Stress About Surgery

If you have MS and need surgery—either to address your symptoms or for another reason—hearing that the medical community holds contradictory opinions about the safety of having anesthesia if you have MS can be anxiety inducing.

While it is true that all types of surgeries come with risk, the latest research shows that having anesthesia during surgery is not any riskier for someone with MS than it would be for someone without the disease.

When you have an upcoming surgery and are worried that having MS will increase your risk of complications, try to remind yourself that the surgery benefits far outweigh the risks.

Keeping yourself calm with techniques such as breathing exercises or meditation can help to relieve some of the stress and fear that you feel about having surgery.

Postsurgical Care

Following surgery, there are some measures you will be expected to take to aid in your recovery. Many of these strategies are helpful for anyone in recovery, not just people with MS.

Easing Into Physical Therapy 

According to research, patients who have just undergone surgery can benefit from starting physical therapy the day of their surgery. However, the timing will depend on the type of surgery that you had and the level of weakness or pain that you experience.

People with MS often feel muscle weakness even prior to surgery, and this could make physical therapy after the procedure that much more difficult. It’s important to listen to the advice of your healthcare provider and start slowly once you feel you are ready. 

Taking Your Medication as Prescribed

Your doctor will talk to you about any medications that you need to take following your surgery. Types of medications that are commonly prescribed after surgery include:

• Pain relievers
• Blood-thinning medications
• Other medications to reduce symptoms such as nausea that can follow a surgery

If you are taking medications for your MS, your doctor will prescribe medications that do not interact negatively with the medications you already take. They will also develop a plan for you to continue with your treatment while you are recovering from surgery.

Rest When You’re Tired

One of the most important things that you can do for yourself during recovery is rest when you are tired. If you push yourself too hard following surgery, you run the risk of slowing the healing process.

Stress is a potential trigger for MS flare-ups as well. If you put too much stress on your body and mind you may run the risk of your symptoms relapsing.

Take Care of Your Incision Wound

Getting an infection after having surgery can lead to complications that worsen or bring on MS symptoms. Therefore, it is vital to ensure that your incision is taken care of after your surgery. You want to make sure that it is cleaned properly every day to avoid infection.

Monitor for Infection Symptoms

If you have a fever or any other signs of infection (such as shortness of breath, chills, or sweats) contact your doctor. Since an infection can bring on MS symptoms, it’s important to monitor yourself for any signs and contact your healthcare provider as soon as you notice them.

Summary

According to the most recent research, anesthesia and surgery are generally considered safe for people with MS. The old controversy about anesthesia and MS is confusing for people who have the condition, but there is a lack of evidence to support that having anesthesia will make MS symptoms worse.

A Word From Verywell 

If you are scared of having an MS relapse after surgery, make sure to bring up your concerns with your healthcare team. They will discuss the benefits and risks of your surgery with you and make sure that you feel empowered to make an informed decision.