title: Is paracervical block safe and effective? A prospective study of its association with neonatal umbilical artery pH values.
abstract: BACKGROUND
  Paracervical blocks (PCBs) relieve labor pain, but reports of associated complications have caused many physicians to question their safety.
  
  
  METHODS
  We designed a prospective observational study to examine the association between PCBs and umbilical artery hydrogen ion concentration (pH) values. A total of 261 healthy women in labor were recruited from a community hospital. Physicians used 1% lidocaine for the PCBs. We used multivariate linear regression to model predictors of umbilical artery pH at birth.
  
  
  RESULTS
  Of the women studied, 238 (91%) received analgesia during labor (nalbuphine, PCB, pudendal, caudal, or epidural). Of these, 126 (48%) received at least one PCB (191 were given), and 197 (76%) received at least one dose of nalbuphine (237 were given). Univariate analyses showed no significant differences in mean 1-minute Apgar scores, 5-minute Apgar scores, umbilical artery pH, resuscitation with oxygen by mask, or length of newborn stay according to either PCB or nalbuphine exposure. Factors significantly associated with lower umbilical artery pH in a linear regression analysis included longer second stage of labor (-0.032 pH units for each 1-hour increase; 95% confidence interval [CI], -.046 to -.018), pudendal block (-0.022; 95% CI, -.040 to -.004), intrauterine pressure catheter use (-0.029; 95% CI, -0.053 to -.006), nuchal cord (-0.027; 95% CI, -.051 to -.004), and midforceps delivery (-0.080; 95% CI, -.159 to .000). Increasing maternal age and induction with either artificial rupture of membranes or gel were associated with higher umbilical artery pH values.
  
  
  CONCLUSIONS
  After adjusting for other variables, neither PCB nor nalbuphine use were associated with umbilical artery pH at birth. PCBs using 1% lidocaine injected superficially should be considered a safe and effective form of obstetric analgesia. PCBs may be especially useful for women giving birth in hospitals where other obstetric anesthesia services are not readily available.
authors.affiliation: Department of Family Medicine, University of Iowa, Iowa City 52242, USA. barcey-levy@uiowa.edu
authors.forename: B T
authors.initials: BT
authors.lastname: Levy
authors.forename: G R
authors.initials: GR
authors.lastname: Bergus
authors.forename: A
authors.initials: A
authors.lastname: Hartz
authors.forename: M
authors.initials: M
authors.lastname: Lofgren
authors.forename: K
authors.initials: K
authors.lastname: Goldsborough
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D001034:Apgar Score; D016001:Confidence Intervals; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D015999:Multivariate Analysis; D009266:Nalbuphine; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D014469:Umbilical Arteries
chemical_list: D009266:Nalbuphine