New Peripudendal Block in Second Stage of Labour reduces need for episiotomy
In the practice of labour analgesia, the pudendal nerve block (PNB) has been introduced to relieve pain in the second stage of labour. In addition to spontaneous deliveries, it has been used in operative vaginal terminations of labour (forceps deliveries).
The pudendal nerve block was often used in conjunction with the paracervical block and was introduced as a supplement to it. The paracervical block relieves the pain of the first stage of labour. The nervus pudendus block can be used in the second stage of labour. During the pudendal nerve block, the local anaesthetic is injected into the area of the pudendal nerve, which contains the parasympathetic fibers originating from the vagina and perineum, thereby providing adequate analgesia in the second stage of labour.
The use of the traditional nervus pudendus block has also been pushed into the background because it is technically more difficult to perform and requires more accurate anatomical knowledge. The reason for this is that it requires a special long needle and the nerve (pudendal nerve) must be visited during the procedure.
The aim of this study by Artur Beke was to investigate the extent to which the peripudendal block we developed reduces the rate of episiotomy in primiparous and multiparous parents during the second stage of labour. Its advantage is that it provides adequate pain relief for both episiotomy and perineal suturing. The relaxation of the perineum makes the second stage of labour more gentle, reduces the need for an episiotomy, and reduces the possibility of perineal injury. In a prospective randomized study, author examined the extent to which the PPB we developed changed the rate of episiotomies, injury rates.
- A total of 333 primiparas and 324 multiparas were included in the study. In the case of primiparas, they used the PPD procedure in 133 cases, while in the case of multiparas, used it in 103 cases.
- The rate of episiotomy in primiparas was 89/133 (66.9%) with PPD and 181/200 (90.5%) without PPD (p < 0.02).
- In multiparas, the episiotomy rate was 30/103 (29.1%) with PPD and 140/221 (63.3%) without PPD (p < 0.02).
- In the case of primiparas, the rate of perineal injury and lesion was 33/133 (24.8%) with PPD, while without PPD it was 12/200 (6.0%).
- Examining the need for all surgical care (due to episiotomy and/or injury), a total of 103/133 cases of operative surgery were required with PPD (77/4%) while 183/200 cases were required without PPD (91.5%)(p < 0.02).
- In the case of multiparas, the rate of perineal injury and lesion was 11/103 (10.7%) with PPD, while without PPD it was 9/221 (4.1%). In the case of multiparas, a total of 41/103 cases required surgical care with PPD (39.8%), while without PPD, 147/221 cases required surgical care (66.5%)(p < 0.02).
Given that pain impulses, which are primarily involved in the second stage of labour, are transmitted through the pudendal nerve (S2-4), the nerve blockade is suitable for alleviating the pain of the second stage of labour. Despite the fact that many other methods are available to us today, among the regional methods, the application of the peripudendal block we have developed has a raison d’etre. The reason for this lies in the fact that, in addition to pain relief, it also provides relaxation of the perineum, thereby reducing the rate of episiotomies.
The new procedure author developed, the peripudendal block (PPB), is simpler, requires less medication, and can be easily mastered in routine obstetric pain relief practice. During its use, in addition to analgesia, the relaxation of the perineum can also be observed, reducing the need for an episiotomy. It can be combined with other methods such as nitrous oxide or epidural analgesia. Its advantage is that it provides adequate pain relief for both episiotomy and perineal suturing. The relaxation of the perineum makes the second stage of labour more gentle, reduces the need for an episiotomy, and reduces the possibility of perineal injury. Perineal relaxation may be particularly important in preterm births, where in addition to the weaker, less calcified skull, the more vulnerable subependymal vessels are also at increased risk.
Source: Artur Beke; Hindawi Obstetrics and Gynecology International Volume 2022, Article ID 9352540 https://doi.org/10.1155/2022/9352540
