Pudendal nerve block and obstetric simulation

Authors

  • Luís Guedes-Martins Gynecology and Obstetrics Service of Centro Hospitalar do Porto; Centro de Simulação Médica do Porto (CESIMED)
  • Luísa Guedes Anesthesiology Service, Centro Hospitalar São João
  • Joaquim Saraiva Gynecology and Obstetrics Service of Centro Hospitalar do Porto
  • Ana Reynolds Centro de Simulação Médica do Porto (CESIMED)

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v23.i3.8694

Keywords:

Labor analgesia, pudendal nerve block, obstetric simulation

Abstract

Pudendal nerve block was fi rst described in 1908. This is an effective technique of analgesia for the later stages of labor. But the use of analgesic techniques able to relieve pain from the early stages of labor (such as the neuraxial techniques) led the pudendal block for a secondary choice. Even though, it is a simple and safe technique, usually performed by the obstetrician and with an associated low risk of bleeding or infection.

Pudendal nerve block is a technique with scarce training opportunities in clinical practice. Therefore, training of this procedure using obstetric simulators should be considered. Moreover, its practice in simulated scenarios allows familiarization of multidisciplinary teams on its application in different contexts, either emergent or non-emergent intra-partum situations.

The objectives of this work are: (1) to conduct a review of the pudendal nerve block for labor analgesia, focusing on its the main advantages and limitations, (2) to rethink its use in the absence of contraindications or other analgesic techniques, (3 ) to remind the technique of execution through simulation applied to Obstetrics.

Downloads

Download data is not yet available.

References

Müller B. Narkologie. Band II, 88. Berlin: Trankel; 1908. p.15.

King R. Perineal anesthesia in labor. Surg Gynecol Obstet 1916; 23: 615-618.

Rocker I. Obstetric indications for the use of pudendal nerve block analgesia. Br Medical Journal 1956; 14:78-81.

Klink EW. Perineal nerve block: an anatomical and clinical study in the female. Obstet Gynec 1953; 1:137-46.

Kohl GC. New method of pudendal nerve block. Northwest Med 1954; 53:1012-3.

Miller R, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010.

Friedman EA. Labor: Clinical evaluation and management. 2ª ed. New York: Appleton; 1978.

Peisner DB, Rosen MG. Transition from latent to ative labor. Obstet Gynecol 1986; 68:448-51.

Harrison RF, Shore M, Woods T, Mathews G, Gardiner J, Un win A. A comparative study of transcutaneous electrical nerve stimulation (TENS), entonox, pethidine promazine and lumbar epidural for pain relief in labor. Acta Obstet Gynecol Scand 1987; 66:9-14.

Volmanen P, Palomäki O, Ahonen J. Alternatives to neuraxial analgesia for labor. Curr Opin Anaesthesiol 2011; 24:235-41.

Rosen MA. Nitrous oxide for relief of labor pain: A systematic review. Am J Obstet Gynecol 2002; 186:110-26.

Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2012; 29:177-85.

Carstoniu J, Levytam S. Nitrous oxide in early labor-safety and analgesic effi cacy assessed by a double-blind, placebo-controlled study. Anesthesiology 1994; 80:30-5.

Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010; 105: 50-60.

Chestnut D, Polley L, Tsen L, Wong C. Chestnut’s Obstetric Anesthesia: Principles and Practice. Philadelphia: Mosby Elsevier; 2009.

Stav K, Dwyer P, Roberts L. Pudendal neuralgia: fact or fiction?. Obstet Gynecol Surv 2009; 64:190-9.

Standring S. Gray’s Anatomy: the anatomical basis of Medicine and Surgery. Philadelphia: Churchill Livingstone; 1995.

Zador G, Lindmark, G, Nilsson BA. Pudendal block in normal vaginal deliveries. Acta Obstet Gynecol Scand 1974; 34:51-64.

Kuhnert BR, Knapp DR, Kuhnert PM, Prochaska AL. Maternal, fetal and neonatal metabolism of lidocaine. Clin Pharmacol Ther 1979; 26:213-20.

Merkow AJ, McGuiness GA, Erenberg A, Kennedy RL. The neonatal neurobehavioral effects of bupivacaine, mepivacaine and 2-chloroprocaine used for pudendal block. Anesthesiology 1980; 52:309-12.

Langhoff-Roos J, Lindmark G. Analgesia and maternal side effects of pudendal block at delivery. A comparison of three local anesthetics. Acta Obstet Gynecol Scand 1985; 64:269-72.

Schierup L, Schmidt JF, Torp-Jensen A, Rye BA. Pudendal block in vaginal deliveries. Mepivacaine with and without epinephrine. Acta Obstet Gynecol Scand 1988; 67:195-7.

Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev 2012; 4:CD009200.

Romanzi L. Techniques of pudendal nerve block. J Sex Med 2010; 7:1716-9.

Prat-Pradal D, Metge L, Gagnard-Landra C, Mares P, Dauzat M, Godlewski G. Anatomical basis of transgluteal pudendal nerve block. Surg Radiol Anat 2009; 31:289-93.

Abdi S, Shenouda P, Patel N, Saini B, Bharat Y, Calvillo O. A novel technique for pudendal nerve block. Pain Physician 2004; 7:319-22.

Arslan M, Yazici G, Dilek U. Pudendal nerve block for pain relief in episiotomy repair. Int J Gynaecol Obstet 2004; 87:151-2.

Schokman FC, Correy JF. Pudendal block: an obstetric procedure that needs critical evaluation. Asia Oceania J Obstet Gynaecol 1987; 13:495.

Draycott TJ, Crofts JF, Ash JP, Wilson LV, Yard E, Sibanda Thabani, et al. Improving Neonatal Outcome Through Practical Shoulder Dystocia Training. Obstet Gynecol 2008; 112:14-20.

Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG 2006; 113:177-82.

Sørensen JL, Van der Vleuten C, Lindschou J, Gluud C, Ostergaard D, Leblanc V, et al. ‘In situ simulation’ versus ‘off site simulation’ in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial. Trials 2013; 14:220.

Dadiz R, Weinschreider J, Schriefer J, Arnold C, Greves CD, Crosby EC, et al. Interdisciplinary Simulation-Based Training to Improve Delivery Room Communication. Simul Healthc 2013; 8:279-81.

Deering S, Rowland J. Obstetric emergency simulation. Semin Perinatol 2013; 37:179-88.

Burden C, Preshaw J, White P, Draycott TJ, Grant S, Fox R. Usability of virtual-reality simulation training in obstetric ultrasonography: a prospective cohort study. Ultrasound Obstet Gynecol 2013; 42:213-7.

Scholz C, Mann C, Kopp V, Kost B, Kainer F, Fischer MR. High-fidelity simulation increases obstetric self-assurance and skills in undergraduate medical students. J Perinat Med 2012 Jul 13. doi: 10.1515/jpm-2012-0052.

Marques JB, Reynolds A. Shoulder dystocia: an obstetrical emergency. Acta Med Port 2011; 24:613-20.

Pratt SD. Recent trends in simulation for obstetric anesthesia. Curr Opin Anaesthesiol 2012; 25:271-6.

Owen H. Early use of simulation in medical education. Simul Healthc 2012; 7:102-16.

Pratt SD. Focused review: simulation in obstetric anesthesia. Anesth Analg 2012; 114:186-90.

Argani CH, Eichelberger M, Deering S, Satin AJ. The case for simulation as part of a comprehensive patient safety program. Am J Obstet Gynecol 2012; 206:451-5

Marzano D, Frankel J, Smith SB, Andreatta P. A simulation-based scenario to help prepare learners in the management of obstetric emergencies. Simul Healthc 2011; 6:364-9.

To WW. Training in emergency obstetric skills: is it evidence-based? Hong Kong Med J 2011; 17:141-6.

van de Ven J, Houterman S, Steinweg RA, Scherpbier AJ, Wijers W, Mol BW, et al. TOSTI-Trial Group. Reducing errors in health care: cost-effectiveness of multidisciplinary team training in obstetric emergencies (TOSTI study); a randomised controlled trial. BMC Pregnancy Childbirth 2010; 10:59.

Gum L, Greenhill J, Dix K. Clinical simulation in maternity (CSiM): interprofessional learning through simulation team training. Qual Saf Health Care 2010; 19:e19.

Ennen CS, Satin AJ. Training and assessment in obstetrics: the role of simulation. Best Pract Res Clin Obstet Gynaecol 2010; 24:747-58.

Morgan PJ, Pittini R, Regehr G, Marrs C, Haley MF. Evaluating teamwork in a simulated obstetric environment. Anesthesiology 2007; 106:907-15.

Published

2016-03-01

How to Cite

1.
Guedes-Martins L, Guedes L, Saraiva J, Reynolds A. Pudendal nerve block and obstetric simulation. REVNEC [Internet]. 2016Mar.1 [cited 2024Apr.18];23(3):145-50. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/8694

Issue

Section

Review Articles

Most read articles by the same author(s)

Similar Articles

You may also start an advanced similarity search for this article.