Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . badly diseased ordevitalized tissues, yet in cases of amputation it is at a favorablesite for drainage should suppuration occur, and may ofter the best i86 LOCAL ANESTHESLX. and safest means of getting rid of an offending member whengangrenous or otherwise diseased. Hackenbruch recommended a method of regional anesthesia,which he called circular anesthesia, by
Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice . badly diseased ordevitalized tissues, yet in cases of amputation it is at a favorablesite for drainage should suppuration occur, and may ofter the best i86 LOCAL ANESTHESLX. and safest means of getting rid of an offending member whengangrenous or otherwise diseased. Hackenbruch recommended a method of regional anesthesia,which he called circular anesthesia, by creating a wall of infiltrationedema around the region to be operated upon, and in this way inter-rupts the conductivity of all nerves entering the area (Fig. 19). Thisis a highly useful method, but applicable only to Hmited areas, for,if too extensive, nerves may enter the area from below at pointswhich cannot readily be reached by the infiltrating solution. Whenoperating by this method, the infiltration of the entire area shouldbe completed before beginning to operate. This plan is particularlyapplicable to cysts, carbuncles, boils, infected and inflamed areas, --Zone of field of operaTion. I Vertical section through tissues taking inmargin of infill rated area, showing methodof undermining field of operation with awall oj anesthetic fiuid. Fig. 19.—Shows method of using Hackenbruch anesthesia around a tumor, carbuncle,or other superficially situated lesion. where direct infiltration, of the inflamed tissues, is to be avoided; itis also useful in the removal of epitheliomata and other malignantdisease, when superficially situated and of limited extent; this methodof operating, and that by the other regional methods, are the onlylocal anesthetic procedures which should be considered when deal-ing with malignancy, as no injections should be made which approachthe limits of the growths, as their infiltration may produce a dis-semination of th
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