MS attacks and Anesthesia

9/30/2017

Here is My Question:
I'm a 35 year old female diagnosed 1 year ago with RRMS, but based on symptoms, we suspect I have had it for 15 to 20 years. I had surgery 2 months ago, and an exacerbation involving low blood pressure, neck spasms, and bladder retention. I stayed inpatient in the Step Down Unit for 4 days after what was supposed to be an outpatient procedure. My MS Specialist was informed and involved in all phases of care and did not seem too concerned about the incident.

I had a consultation today with a different plastic surgeon about a breast augmentation with local anesthesia and/or twilight sedation. The surgeon refused to do the procedure, citing the adverse effects of lidocaine on MS. He said that the effects after the aforementioned surgery were most likely due to the large amounts of lidocaine and epinephrine injected into incision sites to control bleeding and help with pain management. He also said that with my history, I should never undergo any outpatient surgery procedure. I asked about the -caine injections for dental work, and he was leary about those as well; they could either cause permanent nerve damage or no pain relief/fast metabolizing of the numbing agent, thus causing severe pain during dental work.

I have 21+ lesions on my brain, C2, T3, and T4 spinal cord lesions.

I know that cosmetic surgery isn't contraindicated just because a patient has MS, but is there any merit to what this surgeon had advised?

Thank you for your advice.

Answer:
Find a new surgeon/anesthetist. This issue comes up more than you might got think. The literature suggests an association between MS attacks and anesthesia; however, there is no established causal relationship. I suspect that heat/temperature change that can occur with surgery and anesthesia may bring out "pseudo-attacks" of older symptoms from prior nervous system injury due to MS.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

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Lyn

10/2/2017 04:35:48 am

If you were given opiate painkillers for the surgery, that very well could be the reason for the urinary retention. My gi/uro systems shut down using opiates. I generally won the extended stay package as well post-surgery.

I've had a few surgeries now, and my anaesthesiologists have learned to work around using opiate painkillers, or even fentanyl during the anaesthetic process, in order to minimize the issue.

I felt I should mention in case anyone else is as hypersensitive to those meds as I am and reads this. They also reduce my drive to breathe.

SH link

10/4/2017 01:30:14 pm

Good point, Lyn. Not sure if/what medications were used during surgery. I have something set tentatively with another plastic surgeon. This new office wants my bloodwork and information about my MS. This will determine aftercare. I'm relieved to see Dr. Nielsen's response and I will share it with them. In addition, I will follow up during my post-op to see if there were any narcotics in the drug cocktail in the OR. As far as urinary retention issues go, this wasn't the first time I have had problems. But, in general, I don't like prescription pain medication. I would prefer an anti-inflammatory or muscle relaxer that actually works on the problem, or I would prefer homeopathic treatments and/or alternative medicine. Anything I can do to reduce the amount of daily meds, the better!

The more pressing concern would be with the -caine medications. My dentist is hesitant to treat. I'm hesitant to go to those appointments.

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