Bilateral paravertebral block: a satisfactory alternative for labour analgesia.

PURPOSE: To describe a new technique of paravertebral block for labour analgesia and to report the successful use of bilateral paravertebral block in four parturients with contraindications to conventional labour epidural analgesia. CLINICAL FEATURES: Four parturients with contraindications to lumbar epidural analgesia, who were seen either in consultation prenatally or after requesting analgesia when in labour, consented to paravertebral blocks for the management of first stage of labour pain. Bilateral paravertebral blocks were performed at T10-L1 level, initially blocking all four levels with 4 ml bupivacaine 0.5% with epinephrine 1:200000 and then reducing the number of levels blocked to two and finally one. With the entry point 2 cm lateral to the inferior edge of the T11 spinous process, a 22G spinal needle was advanced perpendicular to all planes until contact was made with the transverse/superior articular process of T12, at a depth of 3-5 cm. The needle was then walked superiorly (T11) and inferiorly (T12 nerve root) off the transverse/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 the first stage of labour and could be an alternative analgesic technique for some parturients with contraindications to conventional labour epidurals.