Managing Complications in Pregnancy and Childbirth: - IAWG

PARACERVICAL BLOCK P-1TABLE P-1Indications and precautions for paracervical blockIndications• Dilatation and curettage• Manual vacuum aspirationPrecautions• Make sure there are no knownallergies to lignocaine or relateddrugs• Do not inject into a vessel• Maternal complications are rare butmay include haematoma• Review general care principles (page C-17).• Prepare 20 mL 0.5% lignocaine solution without adrenaline (page C-39).• Use a 3.5 cm, 22-gauge or 25-gauge needle to inject the lignocainesolution.• If using a tenaculum to grasp the cervix, first inject 1 mL of 0.5%lignocaine solution into the anterior or posterior lip of the cervixwhich has been exposed by the speculum (the 10 o’clock or 12o’clock position is usually used).Note: With incomplete abortion, a ring (sponge) forceps ispreferable as it is less likely than the tenaculum to tear the cervixwith traction and does not require the use of lignocaine forplacement.• With the tenaculum or ring forceps on the cervix vertically (onetooth in the external os, the other on the face of the cervix), useslight traction and movement to help identify the area between thesmooth cervical epithelium and the vaginal tissue. This is the sitefor insertion of the needle around the cervix.• Insert the needle just under the epithelium.Tip: Some practitioners have suggested the following step to divertthe woman’s attention from the insertion of the needle: Place thetip of the needle just over the site selected for insertion and ask thewoman to cough. This will “pop” the needle just under the surfaceof the tissue.Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully and