II. Indication

  1. Late first stage and second stage Labor Analgesia

III. Mechanism

  1. Blocks Pudendal Nerve at levels S2 to S4

IV. Procedure

  1. Hold Needle guide with first 2 fingers
  2. Middle finger resting on ischial spine
  3. Insert needle through guide into the pudendal canals
    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, Polocaine or Chloroprocaine 2% and repeat on the opposite side

V. Advantages

  1. No maternal Hypotension
  2. Rare Fetal Distress

VI. Disadvantages: Incomplete analgesia

  1. Patient loses reflex to bear down
    1. Reserved for use immediately prior to impending delivery
  2. Contraction pain still felt
  3. Episiotomy extensions may not be fully covered
  4. Rare use in practice
    1. Ford (2013) J Obstet Gynaecol 33(5):463-5 [PubMed]

VII. Complications (if injecting too deep)

  1. Systemic toxicity
  2. Rectal puncture
  3. Hematoma formation
  4. Sciatic block
  5. Infection
  6. Nerve Injury

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