Pudendal vs. Cervical Block: Anesthesia for Pain Relief During Labor and Delivery (Nursing)

00:01 There are two other anesthesia options that we may use.

00:05 Now, these are oldie but goodies.

00:07 We don't use them very often anymore but it's important that the nurse knows what they are because they are very effective.

00:13 The first one is a pudendal block. The second one is a cervical block.

00:18 Let's look at the pudendal block.

00:21 For a pudendal block, the needle is actually introduced through the sacrospinous ligament and that allows the medication to bathe the pudendal nerve and make everything numb.

00:33 So, the pudendal block works really well when you have a really difficult repair or for a forceps delivery.

00:39 It used to be called a saddle block back in the day.

00:43 So, back when I was a youngster and that was because it bathes the nerves and numbs everything that would be covered if you sat on a saddle.

00:51 I know, just call it a pudendal block. That works great.

00:55 So, what the nurse does is that they will gather the materials that are needed in order to perform the pudendal block.

01:02 They will prepare the client in terms of positioning but also making sure that they understand what the procedure is and what they can expect to feel or not feel.

01:11 So, the pudendal block is not going to do anything for the contractions.

01:15 So, if they're hoping to get any relief from that, it won't happen with this option.

01:19 It's only going to take care of what's covered in the saddle.

01:22 So, thinking about what's going on in the internal structure of the legs and the perineum, that's it.

01:27 Nothing above that. And also, after the pudendal block is done, making sure that the nurse monitors the patient and the fetus to make sure everything is okay.

01:37 There always is a potential for complications and because we're using another medication called lidocaine, if it's injected into the wrong space, it can cause a change in vital signs both for the birthing person and for the fetus.

01:51 And finally, I just want to mention a cervical block.

01:54 Now, a cervical block is a procedure where we actually place lidocaine into the cervix itself and it numbs the cervix for procedures.

02:03 So, sometimes, you'll see this used by the perinatal specialists or you might, you see it used to place a cerclage or it may be used for certain procedures.

02:12 So, you won't see this too often in labor and delivery but I want to make sure that you know what it is.

02:18 Before we leave our discussion about pharmacologic pain relief, I want to make sure that you understand when it's appropriate to use each method.

02:26 So, general anesthesia, this is when a client is completely unconscious.

02:31 They don't feel anything. May be used during a cesarean birth and typically, this is going to be an option for clients when the baby must be delivered right now.

02:41 So, if we have time, we're going to do an epidural or a spinal because the client can be awake and experience birth but if that is not possible due to time, then, general anesthesia will be performed.

02:54 A pudendal block as we just mentioned might be used at the end of first stage where a client has experienced an urge to push and it's not time.

03:03 The cervix is not completely open or perhaps if we need to perform a difficult, mechanical delivery with the forceps or vacuum or we have a difficult and deep repair, to offer some relief from discomfort from that.

03:16 Nitrous oxide, remember, is the inhaled analgesic.

03:20 It can be used throughout the entire labor experience all the way through.

03:24 An epidural can be placed at any time.

03:28 Typically, it's usually placed after someone is in a more active stage of labor but it can actually be placed whenever it needs to be.

03:36 And the only criteria is that the patient is able to maintain a proper positioning and they don't have any of those other contraindications.

03:43 A spinal anesthesia can be used if we need to do a quick set-up.

03:47 An epidural typically takes about 30 minutes to get to full efficacy.

03:51 A spinal can happen within minutes.

03:54 So, if we have a situation where we want to get the baby delivered pretty soon, a spinal's going to be a better option than an epidural.

04:02 Okay, an opioid agonist or an opioid agonist-antagonist is going to be given, remember, IV or IM, usually, after labor's established but not an hour or two prior to delivery.

04:16 And finally, a local. So, local is usually going to be lidocaine and a lidocaine is the medication that would be used in a pudendal block or in a cervical block or it may be just used on surrounding tissue as a repair is performed for a laceration.