. 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. of waiting fifteen totwenty minutes after the injection, is of advantage here. But incase it is desirable to proceed at once, and the skin in the middleline is not anesthetic, it can be infiltrated intradermally and the in-cision made at once, as the deeper parts will be found well anesthetized. Before opening the hernial sac it should be observed whether
. 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. of waiting fifteen totwenty minutes after the injection, is of advantage here. But incase it is desirable to proceed at once, and the skin in the middleline is not anesthetic, it can be infiltrated intradermally and the in-cision made at once, as the deeper parts will be found well anesthetized. Before opening the hernial sac it should be observed whether ornot it is the bladder, which is very common in these hernias, and maybe opened in looking for the peritoneal investment. The neck of the sac is freed and Gimbernats ligament divided,when reduction is usually easy. Closure can then be accomplishedby any recognized method, after first anesthetizing the neck ofthe sac. 360 LOCAL ANESTHESIA The solution used here is the same as for inguinal hernia (No. 1novocain, per cent.; sodium chlorid, per cent; and adrenalin,10 to 15 drops). UMBILICAL HERNIA In very fat individuals with large hernia? and many adhesions andtense abdominal walls this operation may be difficult under local. Fig. 89.—Method of injection around umbilical hernia. (From Braun.) anesthesia, nevertheless it can be performed; but in thin or moder-ately stout patients, unless the condition is very severe, it can bequite satisfactorily performed. HERNIA 361 In all these operations the mechanical difficulties are very muchlessened by putting the patient to bed for a few days, on restricteddiet, with daily laxatives. This relaxes the abdominal walls andrelieves the intra-abdominal tension, and approximation of the gapcan be much more easily obtained. With Solution No. 1 several stations in the skin are anesthetized;if the hernia is small, one on each side; if large, one above and onebelow, in the median line, in addition (Figs. 89, 90). By entering atthese poi
Size: 1417px × 1763px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectanesthe, bookyear1914
