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 . n-filtration. The incisions made to expose these nerves should not be perma-nently closed until the operation is completed, but only loosely ap-proximated with superficial stitches, for if anesthesia is not completeit may be necessary to reopen the wounds for further infiltration of THE UPPER AND LOWER EXTREMITIES 269 the nerves; this, however, will not be at a
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 . n-filtration. The incisions made to expose these nerves should not be perma-nently closed until the operation is completed, but only loosely ap-proximated with superficial stitches, for if anesthesia is not completeit may be necessary to reopen the wounds for further infiltration of THE UPPER AND LOWER EXTREMITIES 269 the nerves; this, however, will not be at all likely if the nerve has beenproperly infiltrated, producing a fusiform enlargement at the pointof injection, in the case of a very large nerve like the great sciaticentering the needle at two or more points in the nerve. As men-tioned elsewhere, this should be done with a very fine needle enteredin the long axis of the nerve-fibers; care should also be observed notto make traction on the nerve, which will cause pain, but to makethe injection when the nerv^e is slack. Some operators in discussingthese operations have preferred, after injecting the anterior cruraland external cutaneous nerves at Pouparts ligament, to infiltrate. Fig. 51.—Method of securing anesthesia of femur for supracondyloid osteotomy. (Braun.) the superficial tissues on the back of the thigh, making the handle ofthe racket incision first, and exposing the sciatic nerve or its branchesat the upper part of this incision and injecting them high up here,then infiltrating the recognized course of the obturator nerve. Theobjection we have to ofter to this procedure is that the small sciatic isnot injected, and its territory, together with that of any of the bran-ches of the great sciatic given off above the point of its injection, willhave to be infiltrated. In the operations about the knee-joint—disarticulations and Gritti-Stokes amputation—these objections arenot of as much consequence, as the area here
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