. Regional anesthesia : its technic and clinical application . tion : The bayonetlock has turned clockwise 180 degrees and completely secured the needle. The syringeis ready for use. injected each time the syringe is emptied; and, as a result, the solutionis exhausted before the required number of injections have been is, therefore, imperative that the exact quantity of solution be takeneach time in the syringe, in order to avoid using excessive doses of the1 per cent, solution to complete the anesthesia, especially in the para-vertebral and sacral procedures. GENERAL PRINCIPLES OF TEC
. Regional anesthesia : its technic and clinical application . tion : The bayonetlock has turned clockwise 180 degrees and completely secured the needle. The syringeis ready for use. injected each time the syringe is emptied; and, as a result, the solutionis exhausted before the required number of injections have been is, therefore, imperative that the exact quantity of solution be takeneach time in the syringe, in order to avoid using excessive doses of the1 per cent, solution to complete the anesthesia, especially in the para-vertebral and sacral procedures. GENERAL PRINCIPLES OF TECHNIC 45 Landmarks.—^Landmarks are the anatomic features of the body thatserve to locate the nerves, or as reliable guides to approach them. Theyare of two kinds, viz., superficial and deep. Superficial landmarks are the anatomic features of the surface ofthe body obtainable by sight or by palpation of the soft structuresoverlying the framework. They are used either as definitive landmarks,or as a means of approaching the deep landmarks. Examples of defini-. Manner of holding the syringe while injecting. tive superficial landmarks are: Blood-vessels, when blocking the cervicalplexus (external jugular vein), the brachial plexus (subclavian artery,axiUary artery), the anterior crural nerve (femoral artery). Muscles,when blocking the cervical plexus (sternocleidomastoid muscle), theterminal branches of the intercostal nerves (recti muscles), and soforth. Bones, when blocking the ulnar nerve at the elbow (internalcondyle and olecranon), and so forth. Tendons, when blocking the 46 REGIONAL ANESTHESIA median nerve at the elbow (biceps tendon), above the wrist (pahnarislongus and flexor carpi radialis), and so forth. Superficial landmarks are used as a means of approaching the deeplandmarks, especially when blocking the trigeminus and its branchesand in paravertebral and sacral block. They should be taken withgreat accuracy so as not to be misleading, and the patient should notbe all
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