Managing Complications in Pregnancy and Childbirth: - IAWG

Pudendal blockP-5VAGINAL APPROACH• Wearing high-level disinfected gloves, use the left index finger topalpate the woman’s left ischial spine through the vaginal wall (FigP-3).FIGURE P-3Vaginal approach without a needle guide• Use the right hand to advance the needle guide (“trumpet”)towards the left spine, keeping the left fingertip at the end of theneedle guide.• Place the needle guide just below the tip of the ischial spine.Remember to keep the fingertip near the end of the needle guide.Do not place the fingertip beyond the end of the needle guide asneedle-stick injury can easily occur.• Advance a 15 cm, 22-gauge needle with attached syringe throughthe guide.• Penetrate the vaginal mucosa until the needle pierces thesacrospinous ligament.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.