Pudendal and paracervical block
- Alex C Vidaeff, MD, MPH
Alex C Vidaeff, MD, MPH
- Professor of Obstetrics and Gynecology
- Department of Obstetrics and Gynecology
- Baylor College of Medicine
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- David L Hepner, MD
David L Hepner, MD
- Section Editor — Obstetric Anesthesia
- Associate Professor of Anaesthesia
- Harvard Medical School
Pudendal and paracervical blocks are typically administered by the patient's obstetrician or gynecologist, rather than an anesthesiologist.
●Pudendal block is used to alleviate pain from minor surgical procedures involving the perineum and from vaginal and perineal distension during the second stage of labor.
●Paracervical block is most commonly used to provide analgesia during gynecological procedures involving cervical dilation. Although it provides some relief from painful uterine contractions and the pain of cervical dilation during the active phase of labor, it is not commonly used for labor analgesia in the United States because of the widespread availability of other safe and effective options, and some historical concerns about its effect on the fetus, particularly when longer-acting local anesthetic agents in high concentrations were used.
Local nerve blocks have several advantages: they are easily learned and simple to perform; when used in obstetrical patients, they do not appear to significantly interfere with the physiologic progression of labor; and they are generally safe for the woman and fetus, as long as the anesthetic is not injected intravascularly and excessive doses are not administered.
The lower vagina, perineum, and vulva obtain most of their sensory and motor innervation from sacral nerve roots 2, 3, and 4 via the pudendal nerve. Infiltration of a local anesthetic around the trunk of the pudendal nerve at the level of the ischial spine results in analgesia of these areas.
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- PUDENDAL BLOCK
- Outcome and efficacy
- PARACERVICAL BLOCK (GYNECOLOGIC)
- Vasovagal syncope
- PARACERVICAL BLOCK (OBSTETRICAL)
- Outcome and efficacy
- - Post-block fetal bradycardia
- - Systemic toxicity after intravascular administration
- - Other
- SUMMARY AND RECOMMENDATIONS