II. Indication
- Late first stage and second stage Labor Analgesia
III. Mechanism
- Blocks Pudendal Nerve at levels S2 to S4
IV. Procedure
- Hold Needle guide with first 2 fingers
- Middle finger resting on ischial spine
- Insert needle through guide into the pudendal canals
- Lateral to ischial spine
- Inferior to sacrospinous ligament
- Aspirate prior to injection to avoid Pudendal Artery
- Inject 10 ml 1% Lidocaine, Polocaine or Chloroprocaine 2% and repeat on the opposite side
V. Advantages
- No maternal Hypotension
- Rare Fetal Distress
VI. Disadvantages: Incomplete analgesia
- Patient loses reflex to bear down
- Reserved for use immediately prior to impending delivery
- Contraction pain still felt
- Episiotomy extensions may not be fully covered
- Rare use in practice
VII. Complications (if injecting too deep)
- Systemic toxicity
- Rectal puncture
- Hematoma formation
- Sciatic block
- Infection
- Nerve Injury