Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . ND LOWER EXTREMITIES 251 in Fig. 38,1, also almost the entire flexor surface of the forearm and a part of the extensorsurface had become anesthetic. The injection was made at 12 oclock, and about 4oclock in the afternoon sensation returned. Anesthesia of a part of a linger can be obtained by direct localinfiltration; more often the anesthesia of an entire finge
Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . ND LOWER EXTREMITIES 251 in Fig. 38,1, also almost the entire flexor surface of the forearm and a part of the extensorsurface had become anesthetic. The injection was made at 12 oclock, and about 4oclock in the afternoon sensation returned. Anesthesia of a part of a linger can be obtained by direct localinfiltration; more often the anesthesia of an entire finger is necessary,especially in inflammatory afiections (bone felons, panaritium, teno-synovitis, traumatism, foreign bodies, etc.). In all such cases theparaneural infiltration method applied at the root of the fingers willyield perfect results. This is the method which we have continu-ously followed in our practice. If, for example, it is a bone felonthat we wish to open, the skin of the root of the finger, a little abovethe level of the palmar web, is infiltrated on the dorsal side (Fig. 39);a fine hypodermic needle is used for infiltration, and a wheal of intra-cuticular edema serves as the starting-point from which a circle of. Fig. 39.—Cross-section of finger: a, Flexor tendon; b, bone; c, extensor tendon; i, and2, points of entrance of needle to reach dorsal and palmar nerves. (From Braun.) anesthesia is carried around the base of the digit. After this hasbeen done, the needle is driven in painlessly through the infiltratedskin into the lateral aspect of the finger in search of the digital nerves,which lie on each side of the phalanx in close proximity to the blood-vessels but superficial to them. The palmar nerves are the largerand more important, and for operations on the palmar aspect of thelast phalanx their anesthesia will prove sufficient, but elsewhere itis better to anesthetise all four nerves as they overlap each other intheir distribution. The palmar nerves are
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