Para-cervical block



Indications
-dilatation and curettage
-Manual vacuum aspiration

Precautions
Confirm no known allergies to lignocaine or related drugs
Do not inject into a vessel
Beware of maternal complications, majorly hematoma

Procedure
Review general care principles related to procedure
Explain procedure to client
Position her well in lithotomy position
Prepare 20ml 0.5% lignocaine solution (do not add adrenaline)
Have a 3.5cm or longer needle, 22 or 25 gauge to use to inject the lignocaine
Place a sizable speculum into he vagina to view the cervix
If using a tenaculum to grasp the cervix, first inject 1ml of the 0.5% lignocaine solution into the anterior or posterior lip of the cervix that has been exposed by the speculum
       Remember: with incomplete abortion, a ring or sponge forceps is preferred as it is less likely than tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement
With the tenaculum or ring forceps on the cervix, vertically, (with one tooth in the external os and the other on the face of the cervix) use slight traction and movement to help identify the area between the smooth cervical epithelium and the vaginal tissue. This is the site for insertion of needle around the cervix
Insert needle just under the epithelium at the 2, 4, 8 and 10 o’clock sites on the cervix. You may also inject at 12 and 6 o’clock
-          You may use a distraction  like place the tip of the needle just over the site selected for injection and ask the woman to cough, this will pop the needle just under the surface of the tissue
Aspirate to be sure that no vessel has been penetrated, if blood is returned on aspiration, remove the needle ,recheck position carefully and try again. Never inject if blood is aspirated due to the danger of adverse drug reaction that could lead to convulsions and even death
Inject 2mls of lignocaine just under the epithelium. When correctly placed, a swelling and blanching of the tissue can be noted.
Wait for two minute then pinch the cervix with forceps, if the woman can feel the pain, wait for two more minutes then retest


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