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Pudendal Block

Indication
1. Late first stage and second stage Labor Analgesia
Mechanism
1. Blocks Pudendal Nerve at levels S2 to S4
Procedure
1. Hold Needle guide with first 2 fingers
2. Middle finger resting on ischial spine
3. Insert needle through guide
  1. Lateral to ischial spine
  2. Inferior to sacrospinous ligament
4. Aspirate prior to injection to avoid Pudendal Artery
5. Inject 10 ml 1% Lidocaine or Polocaine per side
Advantages
1. No maternal hypotension
2. Rare Fetal Distress
Disadvantages: Incomplete analgesia
1. Contraction pain still felt
2. Episiotomy extensions may not be fully covered
Complications (if injecting too deep)
1. Systemic toxicity
2. Rectal puncture
3. Hematoma formation
4. Sciatic block

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.