. 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. is the midline of the subarachnoid space, betweenthe two divisions of the cauda equina. If the needle enters on eitherside, its point may enter the bundle of nerves and the discharged solu-tion be more or less retained among them, leading to one-sided orunsatisfactory anesthesia. Some operators make the puncture directlyin the middle line, between the spin
. 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. is the midline of the subarachnoid space, betweenthe two divisions of the cauda equina. If the needle enters on eitherside, its point may enter the bundle of nerves and the discharged solu-tion be more or less retained among them, leading to one-sided orunsatisfactory anesthesia. Some operators make the puncture directlyin the middle line, between the spines of the vertebra. In this positionit is more difficult to avoid the bony prominences with which theneedle may come in contact. 43° LOCAL ANESTHESIA An easier and equally reliable method is to enter slightly from theside (Figs. 128-130). The point of puncture having been decided upon, we wall say theinterval between the third and fourth lumbar vertebrae (the spineof the fourth vertebra lies on a level with a line drawn between thehighest points of the iliac crests), the finger of the left hand is placedon the spine of the fourth vertebra, and the needle entered aboutj inch to the right and just below the highest point of the spine,. Fif: 130. -Section through vertebral column. Needle in position between spines of fourthand fifth lumbar vertebrae. directing the needle slightly upward and inward at such an anglethat after penetrating 2§ or 3 inches it will reach the dura in themidline. The distance from the surface to the dura varies withincertain limits, according to the stoutness or size of the individual,but it is usually about 2\ or 3 inches. Before making the punc-ture, it is, of course, desirable to render the skin anesthetic, eitherwith ethyl chlorid or with a syringeful of weak novocain or Schleichsolution. After the skin is passed very little sensation is felt by the patient. SPINAL ANALGESIA AND EPIDURAL INJECTIONS 431 Just before entering the canal the needle is fel
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanesthe, bookyear1914
