Paracervical Block

Aka: Paracervical Block

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II. 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 Miscarriage

III. Mechanism

  1. Blocks Sensory Nerve levels T10 to L1

IV. Preparation

  1. Syringe: 10 cc control syringe
  2. Needle: 20 gauge spinal needle
  3. Anesthetic: 2% Lidocaine or 2% Chloroprocaine

V. Procedure

  1. Prepare Cervix
    1. Expose Cervix with medium Graves speculum
    2. Use antiseptic over Cervix and posterior fornix
    3. Apply single toothed tenaculum to anterior Cervix lip
  2. Transvaginal injection of Local Anesthetic
    1. Inject lateral to Cervix on each side
      1. Raise superficial wheal at each site
      2. Aspirate before injecting
    2. Four injection method
      1. Inject 2.5 cc each at 3:00 and 5:00 (left Cervix)
      2. Inject 2.5 cc each at 7:00 and 9:00 (right Cervix)
    3. Two injection method
      1. Inject 5 cc each at 4:00 (left) and 8:00 (right)

VI. Adverse Effects

  1. Postparacervical block Bradycardia (PPCBB)
    1. Occurs in up to 40% of cases
    2. Associated Vasoconstriction of uterine vasculature
    3. Use superficial injection with low dose Anesthetic

VII. Efficacy

  1. Relieves First Stage of Labor pain in 75% of cases

VIII. 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]

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