In Reply:—

We thank Dr. Suelto for her interest in our case report. 1Paravertebral sympathetic block does not provide surgical anesthesia, for which our epidural catheter was primarily intended. Epidural catheter placement was elected because of worsening airway examination in a morbidly obese preeclamptic parturient at high risk for cesarean delivery. Also, the approach to paravertebral sympathetic block is paramedian, which, theoretically, may increase the risk of contact of the needle with the lumboperitoneal shunt because it runs laterally when exiting the dural sac. 2 

As Dr. Suelto mentioned, paravertebral sympathetic block may be an alternative method for labor analgesia. However, we believe that epidural catheter placement was the safest option for our parturient.

Bédard JM, Richardson MG, Wissler RN: Epidural anesthesia in a parturient with a lumboperitoneal shunt. A nesthesiology 1999; 90:621–3
Kassam SH, Hadi HA, Fadel HE, Sims W, Jay WM: Benign intracranial hypertension in pregnancy: Current diagnostic and therapeutic approach. Obstet Gynecol Surv 1983; 38:314–21