Managing Complications in Pregnancy and Childbirth: - IAWG

PUDENDAL BLOCK P-3TABLE P-2Indications and precautions for pudendal blockIndications• Instrumental or breech delivery• Episiotomy and repair of perinealtears• Craniotomy or craniocentesis• Manual removal of placentaPrecautions• Make sure there are no knownallergies to lignocaine or relateddrugs• Do not inject into a vessel• Review general care principles (page C-17).• Prepare 40 mL 0.5% lignocaine solution without adrenaline (page C-39).Note: It is best to limit the pudendal block to 30 mL of solution sothat a maximum of 10 mL of additional solution may be injected intothe perineum during repair of tears, if needed.• Use a 15 cm, 22-gauge needle to inject the lignocaine.The target is the pudendal nerve as it passes through the lesser sciaticnotch. There are two approaches:• through the perineum;• through the vagina.The perineal approach requires no special instrument. For the vaginalapproach, a special needle guide (“trumpet”), if available, providesprotection for the provider’s fingers.PERINEAL APPROACH• Infiltrate the perineal skin on both sides of the vagina using 10 mLof lignocaine solution.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 andtry again. Never inject if blood is aspirated. The woman can sufferconvulsions and death if IV injection of lignocaine occurs.• Wearing high-level disinfected gloves, place two fingers in thevagina and guide the needle through the perineal tissue to the tipof the woman’s left ischial spine (Fig P-2, page P-4).