. 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the eye, ear, nose and throat, and to dental practice. 4 ounce of solution. 366 LOCAL ANESTHESL\ The long needle is now withdrawn and beginning at the primarywheal in the skin this tissue is infiltrated intradermally as far downas the spine of the pubis along the proposed line of incision, whichmay now be made. The idea in making some of the deeper injectionsfirst is to allow them ample time to diffuse and thoroug
. 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the eye, ear, nose and throat, and to dental practice. 4 ounce of solution. 366 LOCAL ANESTHESL\ The long needle is now withdrawn and beginning at the primarywheal in the skin this tissue is infiltrated intradermally as far downas the spine of the pubis along the proposed line of incision, whichmay now be made. The idea in making some of the deeper injectionsfirst is to allow them ample time to diffuse and thoroughly saturateall nerve-fibers in their neighborhood. The first incision is madethrough the skin the entire length of the field but carried downthrough the subcutaneous tissue only in the upper part of the fieldwhere the aponeurosis of the external oblique is exposed. The longneedle is now used and entered at this point; near where it first. Fig. 85.—I, Iliohypogastric nerve; 2, ilio-inguinal nerve; 3, spermatic cord; 4, hernialsac dissected free. The genitocrural nerve is not seen, as it lies within the cord onits posterior aspect. pierced the aponeurosis to reach the iliohypogastric nerve, andpassed downward beneath the aponeurosis to Pouparts ligament,reaching this point about midway between the anterior-superiorspine of the ilium and the pubis; here the ilio-inguinal nerve will befound in the inguinal canal below the cord. A finger held over theskin can guide the progress of the needle; about 2 drams of solutionare deposited along the course of the needle and at this point. The course of the needle is now directed slightly inward but stillclose under the aponeurosis and a little additional solution dci)ositedon each side of the external ring which can now be readily identified HERNIA 367 by palpation through the subcutaneous tissues. We can now freelyexpose the aponeurosis throughout its entire extent by dividing th
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