. Regional anesthesia : its technic and clinical application . e operative area will be cut off, with the exception of the genito-crural, which must be injected at the internal inguinal ring if field-blockis the procedure employed. The sensory element of the spermaticsympathetic plexus is controlled by injecting the structures of thespermatic cord. 1. Reducible Hernia (Brauns Technic).—With the patient lyingin the supine position, two wheals are raised: the first, 3 fingerbreadths 25 386 REGIONAL ANESTHESIA medial to the anterior superior spine of the ilium; the second, exactlyover the horizon
. Regional anesthesia : its technic and clinical application . e operative area will be cut off, with the exception of the genito-crural, which must be injected at the internal inguinal ring if field-blockis the procedure employed. The sensory element of the spermaticsympathetic plexus is controlled by injecting the structures of thespermatic cord. 1. Reducible Hernia (Brauns Technic).—With the patient lyingin the supine position, two wheals are raised: the first, 3 fingerbreadths 25 386 REGIONAL ANESTHESIA medial to the anterior superior spine of the ilium; the second, exactlyover the horizontal ramus of the pubis at the external inguinal the first wheal the muscle layers lying between the whealand the ilium are infiltrated fanwise. About 20 of the per cent,novocain-suprarenin solution are injected in the following manner:Needle No. 3 (8 cm.) or No. 4 (10 cm.), according to the weight of thepatient, is introduced perpendicular to the surface of the skin andadvanced in that direction through the aponeurosis of the external. Fig. 277.—Field-block for reducible inguinal hernia (after Braun). The dottedlines indicate the direction in which the subaponeurotic injections are made; the con-tinuous lines, that of subcutaneous infiltration. oblique muscle and through the muscle layers of the internal obliqueand transversalis. The solution is injected slowly and continuouslywhile the needle advances in the depth. The needle is then partiallywithdrawn and reintroduced twice again, each time in a more obliquedirection toward the ilium until the point of the needle strikes thebone. The solution thus distributed blocks the Diohypogastric and ilio-inguinal nerves. From the same point of entrance further injectionsof from 10 to 20 of the same solution are made in a fork-shaped OPERATIONS ON THE ABDOMEN 387 manner beneath the aponeurosis of the external obHque muscle oneach side of the internal inguinal ring. The needle is then passedthrough the secon
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