Pudendal Nerve Block

The palpating finger is used to locate the ischial spine and sacrospinous ligament per vaginam. The needle is inserted through the vaginal wall, is directed towards the spine and then passed through the sacrospinous ligament. As soon as the needle has passed through the ligament, a loss of resistance is felt. At this point 10mls of local anaesthetic solution (eg 1% Lignocaine with adrenaline) is injected after careful aspiration.

The perineal approach to pudendal nerve block. This approach is particularly useful when the head is fully engaged.