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paracervical block

Injection of local anesthetic into the pelvic-uterine plexus on both sides to provide relief of the pain of cervical dilatation and uterine contractions during the first stage of labor. It is also used in hysteroscopy and vacuum aspiration. It can effectively block by interrupting the transmission of pain sensation as it passes through or close to the cervix. The pain of uterine contractions is conducted through nerves passing close to the cervix. From there, the pain is conducted through multiple fibers to the sympathetic chain at L2-L5. (Procedure) Up to 20 ml of 1% lidocaine (anesthetic agent) is used, usually in divided doses, injected into sites at 10 o'clock, 8 o'clock, 2 o'clock, and 4 o'clock (5 ml each) around 5 mm deep, alongside the vaginal fornices of the cervix.. Usually within 5 minutes, the patient becomes completely pain free, lasting 60-90 minutes. It can be repeated. (Synergism) Ketorolac is a nonsteroidal anti-inflammatory drug used to treat pain. It provides analgesia by inhibiting prostaglandin synthesis by blocking cyclooxygenase 1 and 2 (COX-1 and COX-2). It helps local anesthetics by producing longer duration and better quality of analgesia during peripheral nerve block. Cf. pudendal block