Lumbar Sympathetic Block

Uterine and cervical afferent fibers join the sympathetic chain at L2 and L3. Blockade at this level will provide analgesic for the first stage of labor.

The block is placed bypassing a 22 gauge needle 6-8 cm lateral to the L2 vertebra, angled at 30-45% off the saggital toward the vertebral body. The needle is directed just anterolateral to the vertebral body and 10-15 ml of 0.375-0.50% bupivacaine is injected. This is repeated on the contralateral side.

This block is used most commonly for managing the pain of the first stage of labor when epidural or spinal analgesia is precluded by previous spine surgery. Because it is useful for pain relief during stage one of labor, it is of limited use for obstetrical analgesia.

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