ABSTRACT
Local anaesthetic is injected directly into the cervix (‘intracervical’ or ‘direct’ cervical block), with the patient in the dorsolithotomy position (Fig. 12.1). A standard 21-gauge (green) or 23-gauge (blue) venepuncture needle, 25/27-gauge spinal needle or a 27-gauge dental syringe is used to inject the local anaesthetic solution, which should be distributed equally to all cervical quadrants. This can be achieved by injecting at the 3, 6, 9 and 12 o’clock positions, although some operators may prefer to use alternate sites (e.g. 2, 4, 8 and 10 o’clock). The block may be supplemented at the 5 and 7 o’clock positions, representing the insertions of the uterosacral ligaments into the cervix. The posterior injection sites should be addressed first, followed by the superior sites, as blood tracking down from the cervix can otherwise obscure the view. Application of a tenaculum to the anterior lip of the cervix (after superficially anaesthetizing the lip – ‘blanching’) can be useful to help expose the lateral aspect of the ectocervix in women with lax vaginal walls.
