Is frequently associated with fetal bradycardia

Is frequently associated with fetal bradycardia

1.Paracervical block
2.Pudendal block
3.Spinal block
4.Epidural block

exp:

Pudendal block is perhaps the most common form of anesthesia used for vaginal delivery. It provides adequate pain relief for episiotomy, spontaneous delivery, forceps delivery, or vacuum extraction. The success of a pudendal block depends on a clear understanding of the anatomy of the pudendal nerve and its surroundings. Complications (vaginal hematomas, retropsoas, or pelvic abscesses) are quite rare. Paracervical block was a popular form of anesthesia for the first stage of labor until it was implicated in several fetal deaths. It has been shown that paracervical block was associated with fetal bradycardia in 25% to 35% of cases, probably the response to rapid uptake of the drug from the highly vascular paracervical space with a resultant reduction of uteroplacental blood flow. Death in some cases was related to direct injection of the local anesthetic 150 Obstetrics and Gynecology into the fetus. Low spinal anesthesia (saddle block) provides prompt and adequate relief for spontaneous and instrument-assisted delivery. The local anesthetic is injected at the level of the L4-5 interspace with the patient sitting. Although this method is intended to anesthetize the saddle area, the level of anesthesia may sometimes reach as high as T10. Hypotension and a decrease in uteroplacental perfusion are common results of the profound sympathetic blockade caused by spinal anesthesia. Epidural anesthesia provides effective pain relief for the first and second stages of labor and for delivery. It may be associated with late decelerations suggestive of uteroplacental insufficiency in as many as 20% of cases, but the frequency of this complication may be reduced by prehydration of the mother and by avoiding the supine position. Epidural block appears to lengthen the second stage of labor and is associated with an increased need for augmentation of labor with oxytocin and for instrument-assisted delivery. In experienced hands, however, epidural anesthesia has an excellent safety record.