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Paracervical Block

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Paracervical Block

  • See Also
  1. Active Labor Anesthesia
  2. Latent Labor Anesthesia
  3. Non-Pharmacologic Pain Control in Labor
  4. Epidural Anesthesia
  5. Intrathecal Morphine
  6. Pudendal Block
  7. Manual Uterine Aspiration in First Trimester Pregnancy Loss
  • 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 Early Pregnancy Loss
    1. See Manual Uterine Aspiration in First Trimester Pregnancy Loss
  • Mechanism
  1. Blocks Sensory Nerve levels T10 to L1
  • Preparation
  1. Antiseptic solution (e.g. Povidone-Iodine, Chlorhexidine)
  2. Large cotton swabs (procto swabs)
  3. Syringe: Two 10 cc control syringes
  4. Needle: 20 to 22 gauge spinal needles, 3.5 to 5 cm length
  5. Anesthetic: 1-2% Lidocaine 10 to 20 ml
  • Procedure
  1. Prepare Cervix
    1. Expose Cervix with medium Graves speculum
    2. Apply antiseptic (Povidone-Iodine or Chlorhexidine) to surface of Cervix
      1. Apply in circular motion with large cotton swabs (procto swabs)
      2. Apply to entire Cervix and posterior fornix
    3. Inject 1-2 ml of Lidocaine at the Cervix 12:00 position and wait 60 seconds
    4. Apply single toothed tenaculum to anterior cervical lip (12:00 position)
  2. Cervicovaginal injection of Local Anesthetic
    1. Inject lateral to Cervix at cervicovaginal injection on each side of the Cervix
      1. Raise superficial wheal at each site
      2. Aspirate before injecting
      3. Do NOT inject at the 3:00 and 9:00 positions (location of major vessels)
    2. Two injection method
      1. Inject 5 to 8 cc each at 4:00 (left) and 8:00 (right)
  • Adverse Effects
  1. Postparacervical block Bradycardia (PPCBB)
    1. Occurs in up to 40% of paracervical injections
    2. Associated Vasoconstriction of uterine vasculature
    3. Prevention
      1. Use superficial injection with low dose Anesthetic
      2. Aspirate before injection, and avoid large vessel sites (3:00 and 9:00 positions)
  • Efficacy
  1. Relieves First Stage of Labor pain in 75% of cases
  • 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:S127-30 [PubMed]
  4. Smith (2021) Am Fam Physician 103(6): 355-64 [PubMed]