Paracervical block

TABLE P-1 Indications and precautions for paracervical block

• Review general care principles.

• Prepare 20 mL 0.5% lignocaine solution without adrenaline.

• Use a 3.5 cm, 22-gauge or 25-gauge needle to inject the lignocaine solution.

• 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 cervix which has been exposed by the speculum (the 10 o’clock or 12 o’clock position is usually used).

Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement.

• With the tenaculum or ring forceps on the cervix vertically (one tooth in the external os, the other on the face of the cervix), use slight traction and movement to help identify the area between the smooth cervical epithelium and the vaginal tissue. This is the site for insertion of the needle around the cervix.

• Insert the needle just under the epithelium.

Tip: Some practitioners have suggested the following step to divert the woman’s attention from the insertion of the needle: Place the tip of the needle just over the site selected for insertion and ask the woman to cough. This will “pop” the needle just under the surface of the tissue.

Note: Aspirate (pull back on the plunger) to be sure that no vessel has been penetrated. If blood is returned in the syringe with aspiration, remove the needle. Recheck the position carefully and try again. Never inject if blood is aspirated. The woman can suffer convulsions and death if IV injection of lignocaine occurs.

• Inject 2 mL of lignocaine solution just under the epithelium, not deeper than 3 mm, at 3, 5, 7 and 9 o’clock (Fig P-1). Optional injection sites are at 2 and 10 o’clock. When correctly placed, a swelling and blanching of the tissue can be noted.  Anaesthetize early to provide sufficient time for effect. 

• At the conclusion of the set of injections, wait 2 minutes and then pinch the cervix with forceps. If the woman feels the pinch, wait 2 more minutes and then retest.

Anaesthetize early to provide sufficient time for effect. 

Figure P-1

 Paracervical block injection sites

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