II. Indications
- 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
III. Mechanism
- Blocks Sensory Nerve levels T10 to L1
IV. Preparation
- 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
V. Procedure
- 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
VI. Adverse Effects
- 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)
VII. Efficacy
- Relieves First Stage of Labor pain in 75% of cases
VIII. References
- Curran in Pfenninger (1994) Procedures, p. 675
- Deutchman (2000) ALSO Course Syllabus, p. A18
- Rosen (2002) Am J Obstet Gynecol 186:S127-30 [PubMed]
- Smith (2021) Am Fam Physician 103(6): 355-64 [PubMed]