The pudendal nerve innervates the lower vagina, perineum, and vulva. Block of this nerve will relieve the pain of the second stage of labor. The nerve is blocked at the pudendal canal, just lateral and inferior to the sacrospinal ligament. Ten milliliters (ml) of 0.5% bupivacaine, 1% lidocaine, or 3-2% chloroprocaine is injected bilaterally. Complications are rare, most common are failure of the block and systemic toxicity from inadvertent intravascular injection. When successful, this block supplements analgesia in patients who received paracervical or lumbar sympathetic blocks for the first stage of labor.
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