LEARNING GUIDE 6.2: PUDENDAL BLOCK

(To be completed by Learners)

Rate the performance of each step or task observed using the following rating scale:
1 Needs Improvement: Step or task not performed correctly or out of sequence (if necessary) or is omitted
2 Competently Performed: Step or task performed correctly in proper sequence (if necessary) but learner does not progress from step to step efficiently
3 Proficiently Performed: Step or task efficiently and precisely performed in the proper sequence (if necessary)
LEARNING GUIDE FOR PUDENDAL BLOCK
(Many of the following steps/tasks should be performed simultaneously.) /
STEP/TASK / CASES /
GETTING READY
1.  Prepare the necessary equipment.
2.  Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
3.  Provide continual emotional support and reassurance, as feasible.
4.  Ask about allergies to antiseptics and anesthetics.
PREPROCEDURE TASKS
Note: The preprocedure tasks apply to both the perineal approach and the vaginal approach for pudendal block.
1.  Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
2.  Put new examination or high-level disinfected surgical gloves on both hands.
3.  Clean the vulva with antiseptic solution.
4.  Prepare 40 mL of 0.5% lignocaine solution without adrenaline.
PERINEAL APPROACH
  1. Draw 30 mL of 0.5% lignocaine solution into a syringe.

  1. Infiltrate the perineal skin on both sides of the vagina using 10 mL of lignocaine solution. Aspirate by drawing the plunger back slightly to make sure the needle is not penetrating a blood vessel.

3.  Place two fingers in the vagina and guide the needle through the perineal tissue to the tip of the woman’s left ischial spine.
4.  Inject 10 mL of lignocaine solution in the angle between the ischial spine and the ischial tuberosity.
5.  Pass the needle through the sacrospinous ligament and inject another 10 mL of lignocaine solution.
6.  Repeat the procedure on the opposite side.
7.  Wait 2 minutes and then pinch the cervix with the forceps. (If the woman feels the pinch, wait 2 more minutes and then retest.)
VAGINAL APPROACH
1.  Insert the left index finger into the vagina and palpate the woman’s left ischial spine through the vaginal wall.
2.  Use the right hand to advance the needle guide (trumpet) towards the left spine, keeping the left fingertip at the end of the needle guide.
3.  Place the needle guide just below the tip of the ischial spine.
4.  Advance a 15 cm, 22-gauge needle with attached syringe through the needle guide.
5.  Penetrate the vaginal mucosa until the needle pierces the sacrospinous ligament and aspirate by drawing the plunger back slightly to make sure that the needle is not penetrating a blood vessel.
6.  Inject 10 mL of lignocaine solution.
7.  Withdraw the needle into the guide and reposition the guide to just above the ischial spine.
8.  Penetrate the vaginal mucosa and aspirate again to ensure that no blood vessel has been penetrated.
9.  Inject another 5 mL of lignocaine solution.
10.  Repeat the procedure on the other side, using the right index finger to palpate the woman’s ischial spine and the left hand to advance the needle and needle guide and inject the lignocaine solution.
11.  Wait 2 minutes and then pinch the cervix with the forceps. (If the woman feels the pinch, wait 2 more minutes and then retest.)
POSTPROCEDURE TASKS
Note: The postprocedure tasks apply to both the perineal approach and the vaginal approach for pudendal block.
1.  Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
2.  Place all instruments in 0.5% chlorine solution for 10 minutes for decontamination.
3.  Decontaminate or dispose of needle or syringe:
l  If reusing needle or syringe, fill syringe (with needle attached) with 0.5% chlorine solution and submerge in solution for 10 minutes for decontamination.
l  If disposing of needle and syringe, flush the needle and syringe with 0.5% chlorine solution three times, then place in a puncture-proof container.
  1. Immerse both gloved hands in 0.5% chlorine solution. Remove gloves by turning them inside out.
l  If disposing of gloves, place them in a leakproof container or plastic bag.
l  If reusing surgical gloves, submerge them in 0.5% chlorine solution for 10 minutes for decontamination.
5.  Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.

CHECKLIST 6.2: PUDENDAL BLOCK

(To be used by Learners for practice and by the Teacher at the end of the module)

Place a “” in case box if step/task is performed satisfactorily, an “X” if it is not performed satisfactorily, or N/O if not observed.
Satisfactory: Performs the step or task according to the standard procedure or guidelines
Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines
Not Observed: Step or task not performed by learner during evaluation by teacher

LEARNER ______Date Observed ______

CHECKLIST FOR PUDENDAL BLOCK
(Many of the following steps/tasks should be performed simultaneously.) /
STEP/TASK /

CASES

/
GETTING READY
1.  Prepare the necessary equipment.
2.  Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
3.  Provide continual emotional support and reassurance, as feasible.
4.  Ask about allergies to antiseptics and anesthetics.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
PREPROCEDURE TASKS
1.  Wash hands thoroughly and put on new examination or high-level disinfected surgical gloves.
2.  Clean the vulva with antiseptic solution.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
PERINEAL APPROACH
1.  Infiltrate the perineal skin on both sides of the vagina with lignocaine solution. Aspirate to ensure that no blood vessel has been penetrated.
2.  Inject lignocaine solution between the ischial spine and the ischial tuberosity and through the sacrospinous ligament.
3.  Repeat the procedure on the opposite side.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
VAGINAL APPROACH
1.  Palpate the woman’s left ischial spine through the vaginal wall and advance the needle guide to just below the tip of the ischial spine.
2.  Advance the needle with attached syringe through the needle guide.
3.  Penetrate the vaginal mucosa until the needle pierces the sacrospinous ligament and aspirate to ensure that no blood vessel has been penetrated. Inject lignocaine solution.
4.  Withdraw the needle into the guide and repositions the guide to just above the ischial spine.
5.  Penetrate the vaginal mucosa and aspirate again to ensure that no blood vessel has been penetrated. Inject lignocaine solution.
6.  Repeat the procedure on the other side.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
POSTPROCEDURE TASKS
1.  Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
2.  Place all instruments in 0.5% chlorine solution for decontamination.
3.  If reusing needle or syringe, fill syringe (with needle attached) with 0.5% chlorine solution and submerge in solution for decontamination. If disposing of needle and syringe, place in puncture-proof container.
4.  Remove gloves and discard them in a leakproof container or plastic bag if disposing of or decontaminate them in 0.5% chlorine solution if reusing.
5.  Wash hands thoroughly.
SKILL/ACTIVITY PERFORMED SATISFACTORILY

MCPC Learning Resource Package Module 6, Unsatisfactory Progress of Labor – Page 17