. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the needle downward to thesubcutaneous tissues (Fig. 82), and inject about % ounce in this posi-tion; another \ ounce is injected subcutaneously along the proposed fineof incision by advancing the needle in this direction (Fig. 83), inject-ing as the needle is advanced. If the patient is very stout and there 352 LOCAL ANESTHESIA is much subcutaneous fatty
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the needle downward to thesubcutaneous tissues (Fig. 82), and inject about % ounce in this posi-tion; another \ ounce is injected subcutaneously along the proposed fineof incision by advancing the needle in this direction (Fig. 83), inject-ing as the needle is advanced. If the patient is very stout and there 352 LOCAL ANESTHESIA is much subcutaneous fatty tissue, more than this may be needed, butin the ordinary case the above is sufficient. While we are waiting for these subcutaneous injections to diffuse,the infiltration of the skin is finished by starting at the already in-jected point on the skin, proceeding downward and inward intradermallythe full length of the proposed incision. After this had been done,the incision can be made at once and carried down to the aponeurosisof the external oblique. Expose this freely over the site of the inter-nal ring, and with the large syringe inject about \ ounce of solution justunder the aponeurosis at this point. Now, while waiting for this to. m r Jr. * Fig. 83.—Needle is partially withdrawn from position shown in Fig. 81 and directed sub- cutaneously toward pubes. act, here secure and tie any superficial vessels that may be necessary,and expose the rest of the field by gauze dissection. Then, slit up theaponeurosis of the external oblique to above the internal ring, retract,and you bring into view the iliohypogastric nerve. This has probabiyalready been anesthetized by the last injection, but if there is anydoubt it can be injected intraneurally or perineurally with the smallhypodermic syringe. Retract upward the internal oblique and transversalis to betterexpose the internal ring. If the ilio-inguinal nerve is seen on thelower side of the cord (Fig. 84), infiltrate it at once high u
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanesthe, bookyear1914
