Pudendal block with hyaluronidase.

T 131s is the second report of a study of pudendal block with 1 per cent /)taocaine and hyaluronidase. The cases ilIT 250 completely unselected ser\G cases 9 , -00 blocks with hyaluronidase and 50 blocks without. The enz.ymatic action of hyaluronidase hydrolyzes hyaluronic acid, a \keous l)olysaccharide found in the interstices of t,he tissue, where it normally ol&ructs dif!fusion of invasive sulxtamzes. The basic research defining the \)ro])tJrties of hyalnro~~idase apparently arose from the observations made a,s early a~ 19% 1)~ Duran-Reynals.l St is reasonable to imagine that the enzyme w~~ul~l be applied, if possible, to increa,se the penetration of desired substances ifito the tissues. That this has been feasible seems apparent from the number 01’ papers relating to thcl use of hyaluronidase in hypodern~oclysis.*-3 Hyaluronidase has been discussed favoraldy as an adjunct to local anesthesia in denCstry and numerous surgical PondiCons. The stucly4 of the action of epine])hrine on the spreading factor is of interest. It seems that if a vaso~*tinstrict~~r would decrease the absorption effect, it might also decrease the spreading effe(+. This apparently is not so. The spreading effect, on the contrary! apI)ears to be enhanced 1)~ epinephrine. Presumably this is because the rapid absorptioJ~ caused hy the hyaluronidase prevents t,he maximum spreading which occurs when absorpGon is delayed by a vasoconstrictor. Pregnant women should be ]~sy~~hologically prepared for a certain amount of discomfort in labor anal 1~ told t,hat a moderate amount of pain is normal. Most women fear labor p&s and that fear is responsible for much of thei suffering. These wome~~ should learn tha,t ejrerything will be done for them that is compatible with safet,y for theta am1 their infants, They should understand the doctor’s basis on which he hesitates to relieve the pain of labor completely. Pudendal blc)ck anesthesia for delivery and repair is a near-perfect anesthetic for the patient. the fetus, anal the do&r. The outstanding feature ot the Ill&hod is that marked perineal gaping occurs within three minutes &er t.he inje&ion takes place. This fac+ilitates a, low-forceps delivery, makes (1cJlivery of a breech easier, and minimizes perineal lacerations. The perineal reflex and the resultant urge to hear down iire lost. The patient has to be instructed to bear down to help cleliver the child. The pain of perineal stretchitig will be avoidecl. This pain is 1)~ fan more severe than the other pain assoAat,ed with labor! such as backache and abdominal pain. If this perineal chain is (*otltrolled, t,he ])atient does not suffer.