. Regional anesthesia : its technic and clinical application . of veryshort duration and jHields after a few catheterizations. Incontinenceof urine may also happen and is treated by the use of a permanentcatheter retained for one or two days. Prolonged incontinence or reten-tion are exceptional. They occur in women especially after the posteriorresection of the rectum or a vaginal hysterectomy, and it is hard tohold the method responsible for such conditions, since they may exist BLOCKING OF SPINAL NERVES 269 after similar operations performed under general narcosis. Is it notmore plausible to
. Regional anesthesia : its technic and clinical application . of veryshort duration and jHields after a few catheterizations. Incontinenceof urine may also happen and is treated by the use of a permanentcatheter retained for one or two days. Prolonged incontinence or reten-tion are exceptional. They occur in women especially after the posteriorresection of the rectum or a vaginal hysterectomy, and it is hard tohold the method responsible for such conditions, since they may exist BLOCKING OF SPINAL NERVES 269 after similar operations performed under general narcosis. Is it notmore plausible to incriminate the partial destruction of the innerva-tion of the vesical sphincter in the course of such operations? Massageof the sphincter through the vagina is in such cases indicated; buttime should be allowed for a collateral nerve supply or a new educa-tion of the sphincter to the poor innervation left. PRESACRAL BLOCK With the patient l>ing in the dorsosacral or lithotomy position,the sacrococcygeal joint is defined by passing the tip of the index-. Fig. 203.—Presacral block. The left forefinger marks the right side of the sacro-coccygeal joint, while the needle is inserted through a wheal raised on the left side of thejointat a distance of 2 cm. from the midline. Note the direction of the needle aiming atthe table so as to reach the edge of the sacrum. finger along the lateral margin of the coccjtj, starting from the tip ofthat bone, until it is stopped by the great sacrosciatic ligament (). Two wheals are raised, one on each side of the joint, from 2 cm. distant from the midline. Needle No. 4 (10 cm.) is introducedthrough one of the wheals and advanced toward the anterior surfaceof the sacrum in a direction parallel with the sagittal plane of the body. 270 REGIONAL ANESTHESIA After taking contact with the edge of the sacrum the needle feels itsway past that edge along the anterior surface of the bone until it isstopped at a depth of from 6 to 7 cm. fro
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