Pudendal Anesthesia

Question 1

What areas does a pudendal block provide pain coverage?

Answer 1

Vulva, clitoris, labia, and perineal body.

Question 2

Does a pudendal block affect contractions and cause edema?

Answer 2

No.

Question 3

What is an Iowa Trumpet?

Answer 3

Needle Guide.

Question 4

What size needle is used in a PB?

Answer 4

12-15cm/20-22 gauge spinal needle.

Question 5

What percentage of lidocaine is used in a PB?

Answer 5

1% (10mg/ml); without epinephrine. 3.5-4.0 mg/kg safe dosing.

Question 6

What are your anatomic landmarks for finding the pudendal nerve?

Answer 6

Ischial spines and sacrospinous ligament.

Question 7

How do you ensure you are not in a vessel?

Answer 7

Aspirate, then rotate 180 degrees, and aspirate again.

Question 8

Where do you position the needle guide?

Answer 8

1cm medial and posterior to the ischial spine.

Question 9

Where do you insert the needle?

Answer 9

1cm through the sacrospinous ligament (1-1.5cm beyond the needle guide).

Question 10

How much lidocaine do you initially inject?

Answer 10

3ml

Question 11

What are the signs that the lidocaine went into a blood vessel?

Answer 11

Nausea, dizziness, tinnitus.

Question 12

How much lidocaine is injected after the test dose?

Answer 12

7ml

Question 13

Do you repeat on the opposite side?

Answer 13

Yes.

Question 14

After the 3ml test dose, advance the needle until…

Answer 14

…the sensation of resistance is lost.