Paracervical Block in Obstetrics. an Improved Injection Method: A Clinical and Radiological Study

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Abstract
In the present study, an attempt was made to illustrate radiologically the absorption of the anaesthetic preparation after injection for paracervical block (PCB). The study is based on a series consisting of 20 women who were admitted for legal abortion in the 14th to 19th week of pregnancy. The mixture of contrast medium and anaesthetic was injected at various sites and at various depths in order to study the absorption from the paracervical space during pregnancy. The experiences gained were used as a basis for an improved injection technique. The importance of the injection depth of no more than 3 mm was particularly emphasized. This means that the anaesthetic preparation should always be deposited paracervically just below the epithelium. From here, a slow diffusion of the anaesthetic preparation into the loose intervascular connective tissue occurs instead of, with deeper injections, being deposited directly into the venous plexus of the paracervical tissue, where the risk of intravascular injection is extremely great. At the same time, when the correct technique is used, the risk of depositing the anaesthetic preparation in the lower uterine segment the fetal presenting part, or the nervous plexus of the pelvic wall is avoided. Some other practical aspects are discussed. The improved injection technique has also been used for a personal series of consecutive deliveries, over a 6-month period including 134 patients who were given a total of 204 paracervical blocks. The anaesthetic solution bupivacaine chloride (Marcaine®) was used in a 0.25% solution with the addition of adrenaline 1:400 000 in a dose of 10 ml distributed at four injection sites in the lateral fornices. Apart from a considerably better analgesic effect than previously reported, maternal side effects were also completely lacking. Any PCB-induced fetal effect has also been extremely slight and is subjected to a detailed analysis in the work. With meticulous application of technique and dosage in the present work, paracervical block appears to be free from risk; but with the reservation that it must be handled by an experienced obstetrician.

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