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 Early Pregnancy Loss
    1. See Manual Uterine Aspiration in First Trimester Pregnancy Loss

III. Mechanism

  1. Blocks Sensory Nerve levels T10 to L1

IV. Preparation

  1. Antiseptic solution (e.g. Povidone-Iodine, Chlorhexidine)
  2. Large cotton swabs (procto swabs)
  3. Syringe: Two 10 cc control syringes
  4. Needle: 20 to 22 gauge spinal needles, 3.5 to 5 cm length
  5. Anesthetic: 1-2% Lidocaine 10 to 20 ml

V. Procedure

  1. Prepare Cervix
    1. Expose Cervix with medium Graves speculum
    2. Apply antiseptic (Povidone-Iodine or Chlorhexidine) to surface of Cervix
      1. Apply in circular motion with large cotton swabs (procto swabs)
      2. Apply to entire Cervix and posterior fornix
    3. Inject 1-2 ml of Lidocaine at the Cervix 12:00 position and wait 60 seconds
    4. Apply single toothed tenaculum to anterior cervical lip (12:00 position)
  2. Cervicovaginal injection of Local Anesthetic
    1. Inject lateral to Cervix at cervicovaginal injection on each side of the Cervix
      1. Raise superficial wheal at each site
      2. Aspirate before injecting
      3. Do NOT inject at the 3:00 and 9:00 positions (location of major vessels)
    2. Two injection method
      1. Inject 5 to 8 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 paracervical injections
    2. Associated Vasoconstriction of uterine vasculature
    3. Prevention
      1. Use superficial injection with low dose Anesthetic
      2. Aspirate before injection, and avoid large vessel sites (3:00 and 9:00 positions)

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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Ontology: Paracervical Block (C0030401)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D000773
SnomedCT 14224004
English Block, Paracervical, Blocks, Paracervical, Paracervical Blocks, LA - LA block paracervic nerve, LA block of paracervical nerve, Uterine paracervical block anaesthesia, Uterine paracervical block anesthesia, paracervical (uterine) nerve block, paracervical nerve block (treatment), paracervical nerve block, Paracervical block anesthesia, Paracervical block anaesthesia, Paracervical nerve block, LA - Local anaesthetic block of paracervical nerve, Local anaesthetic block of paracervical nerve, LA - Local anesthetic block of paracervical nerve, Local anesthetic block of paracervical nerve, Uterine paracervical block anesthesia (procedure), Paracervical Block, paracervical block
Spanish anestesia uterina por bloqueo paracervical, anestesia local para bloqueo paracervical, anestesia por bloqueo paracervical, anestesia uterina por bloqueo paracervical (procedimiento)
French Bloc paracervical, BPC (Bloc ParaCervical), Blocs paracervicaux
Norwegian PCB, Paracervikalblokk