I In obstetric practice the pudendal nerve can be blocked with local anaesthetic prior to forceps delivery by inserting a long needle through the vaginal
wall and guided by a finger to the ischial spine, which can be palpated per vaginam. Alternatively, the needle can be introduced just medial to the ischial tuberosity to a depth of 1 in (2.5 cm). When the procedure is carried out bilaterally there is loss of the anal reflex (which is a useful test that a successful block has been achieved), relaxation of the pelvic floor muscles and loss of sensation to the vulva and lower one third of the vagina (see Fig. 99b).
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