To the Editor:—

I read with interest the report of epidural anesthesia in a parturient with a lumboperitoneal shunt. 1Paravertebral lumbar sympathetic block is another method of providing labor analgesia in patients with a history of back surgery or spine disease. 2The technique is well-described. 3–5The block is performed at the L1 or L2 level. This method eliminates the theoretical concern of epidural catheter entanglement with the lumboperitoneal shunt or of trauma to the shunt. Effective analgesia for the first stage of labor can be achieved that lasts up to 9–12 h with the use of 0.25–0.375% bupivacaine with 2 μg/ml epinephrine. 2,3,6However, limitations of the technique include provision of analgesia only for the first stage of labor, and a pudendal block performed by the obstetrician for the second stage may be necessary. Also, another anesthetic technique must be used if a cesarean section was necessary. Although lumbar sympathetic block does not offer the versatility that epidural anesthesia does, it is an alternative method that offers labor analgesia in selected patients.

Bédard JM, Richardson MG, Wissler RN: Epidural anesthesia in a parturient with a lumboperitoneal shunt. A nesthesiology 1999; 90:621–3
Suelto MD, Shaw DB: Labor analgesia with paravertebral lumbar sympathetic block. Reg Anesth Pain Med 1999; 24:179–81
Meguiar RV, Wheeler AS: Lumbar sympathetic block with bupivacaine: Analgesia for labor. Anesth Analg 1978; 57:486–90
Bonica JJ: Lumbar sympathetic block, Principles & Practice of Obstetric Analgesia & Anesthesia. Edited by Bonica JJ. Philadelphia, Davis, 1969, pp 520–6
Brown DL: Lumbar sympathetic block, Atlas of Regional Anesthesia. Edited by Brown DL. Philadelphia, WB Saunders, 1992, pp 239–43
Leighton BL, Halpern SH, Wilson DB: Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women. A nesthesiology 1999; 90:1039–46