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mridulaben · Posted: Mon Feb 05, 2007 2:24 pm Post subject: Analgesia

Paracervical block can provide adequate analgesia in the first stage of labour ???

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

false

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

Absolutly False

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

hey,

sorry i was wrong.
i checked.. Williams says its true. paracervical provides adequate analgesia for stage I , but not enough for stage 2.

Laughing

mridulaben · Posted: Tue Feb 06, 2007 10:37 am Post subject:

Answer is true in strat og.
I also thought it was false but how is it possible that paracervical block can provide adequate analgesia for first stage.

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

I wonder also Question

may we should look for it more closely

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

In first stage, sensory fibres from uterus and cervix are involved, they pass via the frankenhauser's ganglion , which lies lateral to cervix. and then these reach T10-L1.

so paracervical might be blocking at the ganglion level, i guess Wink

II stage pain is via S1-S4 and so requires pudendal block.

mridulaben · Posted: Wed Feb 07, 2007 11:25 am Post subject:

Looks reasonable explaination. Thanks

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

Thanks Vani..

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

hi all,

vani is spot on. good explanation Exclamation

that is the logic behind the paracervical block for stage 1.

the problems with it are...

The failure rate is reported to be as high as 18%.

The proximity of uterine blood vessels in the vaginal fornices creates maternal and fetal risks.

Fetal bradycardia occurs in 10-50% of cases This is attributed to asphyxia which is believed to result from transient uterine artery vasospasm due to high concentrations of local anaesthetic in the paracervical region.

The technique has a duration of action limited to 90 minutes with plain lignocaine. The use of adrenaline or bupivacaine in an attempt to increase the duration of the block should be avoided as both increase the incidence of fetal bradycardia

also one can't have a continuous analgesia as in an epidural, and is a one off technique or will need to be repeated often if that is all we are going to do for the patients, with all the above risks being repeated.

so.... the ans to ur mcq is TRUE, but it is impractical in day to day working.

Very Happy

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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

mridulaben · Posted: Sat Feb 10, 2007 10:41 am Post subject:

Thanks raj u r back. Really useful information.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

ya, i've been gone for a few days. really tough week at work. haven't touched my books for the last 6 days Crying or Very sad

_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Wed Feb 14, 2007 3:00 pm Post subject:

Great work guys and Raj especially Smile

This thread shows how important it is to take one topic at a time and really consider it. How many people would have thought this was correct on first consideration??
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