Neuropathy following Paracervical Block in the Obstetric Patient

Bleeding Risk in Interventional Pain Practice: Assessment, Management, and Review of the Literature

“…Paracervical injections have been associated with maternal demise, due to local anesthetic toxicity (326). Nonetheless, post-mortem studies have demonstrated the presence of blood near the broad ligament (326,327). Blood can spread posterior to the broad ligament and even reach the sacrum (327).…”

“…Nonetheless, post-mortem studies have demonstrated the presence of blood near the broad ligament (326,327). Blood can spread posterior to the broad ligament and even reach the sacrum (327). The absence of blood during aspiration might not exclude the possibility of intravascular penetration (326)(327)(328).…”

“…Blood can spread posterior to the broad ligament and even reach the sacrum (327). The absence of blood during aspiration might not exclude the possibility of intravascular penetration (326)(327)(328). Blind paracervical techniques have a large variation in the degree of needle depth penetration (327), so more superficial paracervical injections are advised to prevent vascular trauma (326,327).…”

“…A pudendal nerve block can injure the internal pudendal artery and lead to a retroperitoneal hematoma (328). Hematomas following pudendal and paracervical blocks can be clinically significant and cause neural injury, such as sacral neuritis (327,328).…”

“…7, No. 1,2004 Minimizing the number of needle passes, during a paracervical block, may reduce the risk of a pelvic hematoma (327). Multiple needle passes, during interscalene blocks, posed a greater risk for developing bruising or inflammation, when compared to a single pass; bruising occurred in 32% and 10% of subjects, if more or less than 4 needle passes were used, respectively (290).…”