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July 11, 1953


Author Affiliations

2008 Walnut St., Philadelphia 3.

JAMA. 1953;152(11):1067. doi:10.1001/jama.1953.03690110081029

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To the Editor:  —In The Journal (May 30, 1953) there was an article entitled "Danger of Lumbar Sympathetic Blocks During Anticoagulant Therapy" by Robert P. Hohf, William S. Dye, and Ormand C. Julian. The authors reported retroperitoneal hemorrhage following paravertebral lumbar sympathetic block during anticoagulant therapy in three patients with peripheral vasospasm. In their comment they state, "It is apparent that there is no way to avoid this catastrophe by modifying the technique by which a block is performed or by regulating the therapeutic dose of anticoagulants." It has been shown that adequate lumbar sympathetic block may be obtained by the injection of dilute solutions of local anesthetics into the epidural space (Ruben, J. E.: Anesth. & Analg.29:296, 1950). This space may be entered for the purpose by the caudal or the interspinous route. A flexible needle (Hingson, R. A., and Southworth, J. L.: Mil. Surgeon100:474,

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