PARACERVICAL-BLOCK - A VIABLE ALTERNATIVE FOR LABOR PAIN RELIEF

Background. Two hundred and forty-eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injecti on technique were studied prospectively during the progress of labor i n the three month study period. Parturients with signs of fetal distre ss were excluded. Pain level and the maternal, fetal and neonatal effe cts related to PCB were evaluated. Methods. Pain intensity level was a ssessed on a visual scoring scale (0-10). The intrapartum fetal heart rate patterns were recorded and reviewed to correlate the incidence of paracervical fetal bradycardia. Results. Parturients with PCB were pr ovided a significant reduction (p<0.001) in pain levels and the change in pain scores could be maintained until the beginning of the second stage. After the block, bradycardia patterns were noted in five (2.0%) fetuses, a fetal heart rate ranged from 60 to 105 beats per minute wi th an onset time of 2-20 minutes after the block and a duration of 4-1 2 minutes. AH newborns in the bradycardia group were delivered vaginal ly without signs of asphyxia. Conclusions. PCB in selected parturients with a low-dose superficial technique has been shown to be an effecti ve analgesic modality with minimal fetal and neonatal side-effects, bu t post-blockade fetal bradycardia cannot be wholly eliminated.