. 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. ellas other details. It is more convenient, when operating by the neuro-regional method, to use a posterior rachet incision, after the posteriorincision has been made, and the deep muscles slightly separated withthe finger to expose the vessels; a long needle is used to infiltrate the THE UPPER AND LOWER EXTREMITIES 251 region around the vessels (the path
. 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. ellas other details. It is more convenient, when operating by the neuro-regional method, to use a posterior rachet incision, after the posteriorincision has been made, and the deep muscles slightly separated withthe finger to expose the vessels; a long needle is used to infiltrate the THE UPPER AND LOWER EXTREMITIES 251 region around the vessels (the path of the obturator nerve) withsolution No. 1 or less freely with per cent, novocain; a few min-utes following this last injection all parts involved in the field ofoperation should be as anesthetic as under general narcosis and thesteps of the operation proceeded with in the usual way. It would seemunnecessary to state that all these operations should be performed withthe use of a constrictor applied to the upper part of the thigh afterthe injection of the crural, external cutaneous, and sciatic nerves. The incisions made to expose these nerves should not be perma-nently closed until the operation is completed, but only loosely ap-. Fig. 50.—Method of securing anesthesia of femur for supracondyloid osteotomy. (Braun.) proximated with superficial stitches, for if anesthesia is not com-plete it may be necessary to reopen the wounds for further infiltra-tion of the nerves; this, however, will not be at all likely if the nervehas been properly infiltrated, producing a fusiform enlargement atthe point of injection, in the case of a very large nerve like the greatsciatic entering the needle at two or more points in the nerve; this,as mentioned elsewhere, should be a very fine needle entered in thelong axis of the nerve-fibers; care should also be observed not to maketraction on the nerve, which will cause pain, but to make the injectionwhen the nerve is slack. Some operators in d
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