Muhammad Mobeen, Hamid Mehmood.
Bilateral Paravertebral Block for labor analgesia.
J Rawal Med Coll Jan ;8(2):57-60.

Background: To describe an alternative technique for labour analgesia and to report the use of bilateral paravertebral block in full term multigravida parturient using 1% lignocaine as an anaesthetic agent. Methods: This prospective study was conducted at labour rooms of Gynae/Obs Department of Military Hospital Rawalpindi between May and October 2002. Twenty full term multigravida parturient who requested analgesia in labour, consented to paravertebral blocks for the management of first stage of labour. Bilateral paravertebral blocks were performed to achieve levels of T10 to L1, using 1% lignocaine with epinephrine 1:200,000. Results: Good analgesia was obtained in 16 patients. 13 patients delivered prior to the resolution of the block, while in 3 patients, pain returned before delivery and 4 patients did not feel any analgesia. Analgesia lasted for 80 ± 20 minutes. In the second stage of labour, analgesia for expulsion was provided by pudendal block or infiltration analgesia. The former 16 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 haemodynamically stable and out of 20, only one patient had transient sharp pleuritic pain at right costal margin which gradually decreased in intensity and completely resolved within 8 hours with no visceral damage. Conclusion: In order to achieve a siutable alternative for conventional epidural analgesia for labour, paravertebral blocks show good results for the management of first stage of labour and offer a useful alternative for some parturient with contraindications to epidurals. Given the ease of performance, degree of analgesia, and stable hemodynamics, this procedure warrants further investigation as an alternative or supplement to parenteral opioids and/or nitrous oxide where facilities of epidural are lacking.

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