Obstetrics Book

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Paracervical Block

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  1. Indications
    1. Rarely used in labor now due to PPCBB (see below)
    2. Pain relief for uterine contractions early first stage
    3. Regional anesthesia for D&C in Miscarriage
  2. Mechanism
    1. Blocks Sensory Nerve levels T10 to L1
  3. Preparation
    1. Syringe: 10 cc control syringe
    2. Needle: 20 gauge spinal needle
    3. Anesthetic: 2% Lidocaine or 2% Chloroprocaine
  4. Procedure
    1. Prepare cervix
      1. Expose cervix with medium Graves speculum
      2. Use antiseptic over cervix and posterior fornix
      3. Apply single toothed tenaculum to anterior cervix lip
    2. Transvaginal injection of local anesthetic
      1. Inject lateral to cervix on each side
        1. Raise superficial wheal at each site
        2. Aspirate before injecting
      2. Four injection method
        1. Inject 2.5 cc each at 3:00 and 5:00 (left cervix)
        2. Inject 2.5 cc each at 7:00 and 9:00 (right cervix)
      3. Two injection method
        1. Inject 5 cc each at 4:00 (left) and 8:00 (right)
  5. Adverse Effects
    1. Postparacervical block Bradycardia (PPCBB)
      1. Occurs in up to 40% of cases
      2. Associated vasoconstriction of uterine vasculature
  6. Efficacy
    1. Relieves First Stage of Labor pain in 75% of cases
  7. References
    1. Curran in Pfenninger (1994) Procedures, p. 675
    2. Deutchman (2000) ALSO Course Syllabus, p. A18
    3. Rosen (2002) Am J Obstet Gynecol 186:S127

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