Conclusion. References

Conclusion

Paracervical block for anesthesia for curettage is carried out without the Brittain Guide. A 3- or 4-inch 21-gauge needle is adequate, and 5 ml of the anesthetic solution is infiltrated at the 4 o'clock position, 5 ml at 8 o'clock and 5 ml directly into each uterosacral ligament. This provides the ideal anesthetic for completion of abortions and it is excellent for curettage in many other circumstances. The method is not recommended in the presence of vaginismus of any cause. It is indicated where general anesthesia or sophisticated forms of conduction anesthesia are either unavailable or contraindicated. It is especially useful if the patient has anemia, has too recently eaten or has a respiratory problem or is in borderline shock. Many patients with incomplete abortions fall into this category. Paracervical block can also be used in other minor procedures such as cervical repair, conization and Shirodkar or Wurm operations, although in such cases it is probably better to reserve it for the exceptionally poor risk patients. Paracervical block has also been recommended as an aid in the differential diagnosis of dysmenorrhea. If the block does not relieve the pain, no benefit can be expected from the Doyle procedure of dividing the uterosacral ligaments or from a presacral neurectomy.

References

1. Aldridge, C. W., Jr., Nanzig, R. P., and Beaton, J. H.: Uterosacral block and the obstetrical anesthesia problem, Amer. J. Obstet. Gynec., 81: 941, 1961.

2. Baken, M. D., Jr., Freeman, D. W., and Barno, A.: Transvaginal regional block anesthesia in labor, Gur. Gynec. Obstet., 114: 375, 1962.

3. Bonica, J. J.: What's New, No. 217, Abbott Laboratories, North Chicago, Spring 1960.

4. Davis, J. E., Frudenfeld, J. C., Frudenfeld, K., and Webb, A. N.: Paracervical block for pain relief in labor, Obstet. Gynec., 19: 195, 1962.

5. Davis, J. E., Frudenfeld, J. C., Frudenfeld, K., Frudenfeld, J. H., and Webb, A. N.: The combined paracervical- pudendal block anesthesia for labor and delivery, Amer. J. Obstet. Gynec., 89: 366, 1964.

6. Davis, J. E., and Frudenfeld, K.: Improved transvaginal needle guide, Obstet. Gynec., 23: 143, 1964.

7. Freeman, D. W., Bellville, T. P., and Barno, A.: Paracervical block anesthesia in labor, Obstet. Gynec., 8: 270, 1956.

8. Kobak, A. J., Sadove, M. S., and Mazeros, W. T.: Anatomic studies of transvaginal regional anesthesia, Obstet. Gynec., 19: 302, 1962.

9. Page, E. P., Kamm, M. L., and Chappell, C. C.: Usefulness of paracervical block in obstetrics, Am. J. Obstet. & Gynec., 81: 1094, 1961

10. Seeds, A. E., Jr., Stein-Messanger, P., and Dorsey, J. H.: Paracervical blocks: Results of a double-blind evaluation, Obstet. Gynec., 20: 462, 1962.

11. Seley, J. E., and Gold, E. M.: Paracervical block in the management of labor, Obstet. Gynec., 27: 116, 1966.

12. Van Praagh, Ian, G. L., and Povey, W. G.: Paracervical block anesthesia in labour, Canadian Med. Assn. J., 94: 262, 1966.

13. White, C. A., and Pitkin, R. M.: Paracervical block anesthesia in obstetrics, Post grad. Med., 33: 585, 1963. I7

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