Transvaginal pudendal nerve block

Pudendal Nerve Block

“…Lately some interest has been focused on the technique of transvaginal pudendal nerve block (Kobak, Evans, and Johnson, 1956;Leshock, 1957). This would appear to be a simple and perhaps preferable approach, since the injection is given direct through the vaginal wall, at the posterior surface of the spine and above in the sacrosciatic notch-a procedure which ensures complete blocking of the pudendal nerve even if it divides higher up above the spine, as it often does.…”

“…Unfortunately this does not take into account the anterior labial branches of the ilio-inguinal nerve and the perineal branches of the posterior femoral cutaneous nerve. Also it is not always possible to use the transvaginal technique owing to lack of space, and occasionally more than one attempt may be necessary to achieve a block (Kobak, Evans, and Johnson, 1956). As a routine procedure, therefore, it is desirable to adhere to the transperineal route and inject at all the three sites as described, through a single entry on each side.…”

“…This is usually remedied by adding hyaluronidase, which increases its spreading properties. Procaine when used with hyaluronidase alone produces a very short-lasting analgesia (Kobak, Evans, and Johnson, 1956), but the addition of 1 :1,000 adrenaline (0.5 ml. adrenaline to 30 ml.…”

“…adrenaline to 30 ml. of procaine) produces a comparatively long-lasting analgesia (Kobak, Evans, and Johnson, 1956). Addition of even minute quantities of adrenaline as above may produce a marked adrenaline effect characterized by complete cessation or otherwise weakening of uterine contraction and tone, lasting for as long as 20 minutes (Woolsey, 1955).…”

Preparations and Appliances

“…The transvaginal method was originally described by Kobak, Evans, and Johnson (1956) and more recentlv…”