Paracervical Block

The paracervical ganglion is located posterolateral to the cervico-uterine junction. Infiltration of the posterolateral aspect of the vaginal fornix will provide adequate analgesia for the first stage of labor in the majority of patients. The ganglia are located at the 4 and 8 o'clock positions, submucosally in the vaginal vault. Fetal badycardia may occur in approximately 40%

Table 22.2 Systemic opioids for labor analgesia.

Drug

Dose/interval

IV/PCA

Meperidine

25-50 mg IV q 2-3 h

a

Morphine

5 mg IV q 23 h

CI 0.2 mg/h PCA 0.5-1 mg q 6 min 4 h lockout 30 mg

Fentanyl

25-50 ^g IV q 1-2 h

CI 25 |ig/h PCA 10 |g q 6 min 4 h lockout 500 |g

Nalbuphine

10-20 mg IV q 3-4 h

a

Butorphanol

1-2 mg IV q 4 h

a

aThese medications are not administered by IV-PCA. IV=intravenous; PCA=patient-controlled analgesia.

aThese medications are not administered by IV-PCA. IV=intravenous; PCA=patient-controlled analgesia.

of the cases, likely related to fetal absorption of local anesthetic. The duration of the block is 30-60 min. Doses of 0.125% bupivacaine, 1% lidocaine, and 3% chloroprocaine have all been used. Chloroprocaine is associated with the lowest incidence of side effects. This block is only effective for the first stage of labor. Because of the frequency of fetal bradycardia, it should not be used in the presence of a non-reassuring FHR pattern.

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