ABSTRACT
INTRODUCTION The choice of analgesia methods for pregnant women with neurological disease must be based on a wide knowledge of pathophysiology and the state of the disease in question. Historically, the use of regional techniques in patients with pre-existing neurological diseases has been considered relatively contraindicated. The fear of worsening neurological outcome secondary to mechanical trauma, local anaesthetic toxicity or neural ischaemia are all common concerns. A retrospective review from Mayo Clinic (1) investigated 139 patients during a period of 12 years with a history of neurological disease who subsequently received neuraxial anaesthesia or analgesia. A satisfactory block was reported in 98% of patients. No new or worsening post-operative neurological deficit occurred when compared to pre-operative findings. The conclusion was the risk commonly associated with neuraxial anaesthesia or analgesia in patients with pre-existing neurological disease may not be as frequent as once was thought. However, post-partum published data on this area are limited. A few disorders contraindicate the use of regional anaesthesia. Early anaesthesia consultation should allow accurate assessment of the extent and pattern of the disease and formulation of the analgesia plan. Neurological disease complicating pregnancies require highly individualised care to balance complex medical conditions and their specific presentations during pregnancy. Consultation with obstetricians and anaesthetists is important to optimise the management of these patients.
