- Rarely used in labor now due to PPCBB (see below)
- Pain relief for uterine contractions early first stage
-
Regional Anesthesia for D&C in Early Pregnancy Loss
- See Manual Uterine Aspiration in First Trimester Pregnancy Loss
- Blocks Sensory Nerve levels T10 to L1
- Antiseptic solution (e.g. Povidone-Iodine, Chlorhexidine)
- Large cotton swabs (procto swabs)
- Syringe: Two 10 cc control syringes
- Needle: 20 to 22 gauge spinal needles, 3.5 to 5 cm length
-
Anesthetic: 1-2% Lidocaine 10 to 20 ml
- Prepare Cervix
- Expose Cervix with medium Graves speculum
- Apply antiseptic (Povidone-Iodine or Chlorhexidine) to surface of Cervix
- Apply in circular motion with large cotton swabs (procto swabs)
- Apply to entire Cervix and posterior fornix
- Inject 1-2 ml of Lidocaine at the Cervix 12:00 position and wait 60 seconds
- Apply single toothed tenaculum to anterior cervical lip (12:00 position)
- Cervicovaginal injection of Local Anesthetic
- Inject lateral to Cervix at cervicovaginal injection on each side of the Cervix
- Raise superficial wheal at each site
- Aspirate before injecting
- Do NOT inject at the 3:00 and 9:00 positions (location of major vessels)
- Two injection method
- Inject 5 to 8 cc each at 4:00 (left) and 8:00 (right)
- Postparacervical block Bradycardia (PPCBB)
- Occurs in up to 40% of paracervical injections
- Associated Vasoconstriction of uterine vasculature
- Prevention
- Use superficial injection with low dose Anesthetic
- Aspirate before injection, and avoid large vessel sites (3:00 and 9:00 positions)
- Relieves First Stage of Labor pain in 75% of cases
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