Experiences with Paracervical Block: A Double‐blind Study with Bupivacaine (Marcaine®)

The authors have studied paracervical blocks with bupivacaine, physiological saline and bupivacaine with adrenalin 1: 200 000 by means of a double‐blind technique. The analgesic effect was good in nearly 80% of the cases with active substance and in about 20% of the cases with physiological saline. The duration of analgesia was shorter when physiological saline was used. No important difference in duration of analgesia was found between bupivacaine and bupivacaine‐adrenalin. Adrenalin did not seem to improve the effect when added to bupivacaine. The dilatation of the cervix was no more rapid when active substance was used than with physiological saline. Bupivacaineadrenalin seemed to be associated with more uterine inertia than bupivacaine and physiological saline. Foetal bradycardia was found in 4%. 2 of the 8 cases of foetal bradycardia were after blocks with physiological saline. All these 8 foetuses were born with Apgar scores of 10. In the whole study there were no Apgar scores below 8. A few maternal complications of short duration were recorded, all when bupivacaine‐adrenalm was used. The authors have the impression that paracervical block is not entirely free fnom risks. Foetal complications may be expected. One case of foetal death, possibly connected with paracervical block using bupivacaine‐adrenalin is described.