Bilateral paravertebral block: a satisfactory alternative for labour analgesia

Purpose: To describe a new technique of paravertebral block for labour anal gesia and to report the successful use of bilateral paravertebral block in four parturients with contraindications to conventional labour epidural ana lgesia. Clinical Features: Four parturients with contraindications to lumbar epidur al analgesia, who were seen either in consultation prenatally or after requ esting analgesia when in labour, consented to paravertebral blocks for the management of first stage of labour pain. Bilateral paravertebral blocks we re performed at T-10-L-1 level, initially blocking all four levels with 4 m l bupivacaine 0.5% with epinephrine 1:200000 and then reducing the number o f levels blocked to two and finally one. With the entry point 2 cm lateral to the inferior edge of the T-11 spinous process, a 22G spinal needle was a dvanced perpendicular to all planes until contact was made with the transve rse superior articular process of T-12, at a depth of 3-5 cm. The needle wa s then walked superiorly (T-11) and inferiorly T-12 nerve root) off the tra nsverse/articular process and advanced 1.5 cm into the paravertebral space. All four patients had relief of pain such that they were "comfortable" and able to cope with labour although they continued to experience deep pelvic and rectal pain, The patients tolerated the initiation of the blocks well, remained hemodynamically stable, and did not suffer any adverse effects. Conclusion: Bilateral paravertebral block provides adequate analgesia for t he first stage of labour and could be an alternative analgesic technique fo r some parturients with contraindications to conventional labour epidurals.