. 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. ned fromits lumen during the process of sterilization. In making the puncture the needle may be used alone or fittedto an extra syringe, which will serve as a handle. The objective sitefor the injection 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 n
. 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. ned fromits lumen during the process of sterilization. In making the puncture the needle may be used alone or fittedto an extra syringe, which will serve as a handle. The objective sitefor the injection 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 dischargedsolution be more or less retained among them, leading to one-sided orunsatisfactory anesthesia. Some operators make the puncture di- 460 LOCAL ANESTHESLA. rectly in the middle line, between the spines of the vertebra. Inthis position it is more difficult to avoid the bony prominences withwhich the needle may come into contact. An easier and equally rehable method is to enter slightly fromthe side (Figs. 131-133). The point of puncture having been decided upon, we will say theinterval between the third and fourth lumbar vertebrae (the spineof the fourth vertebra lies on a level with a line drawn between the. Fig. 131.—Side view of lumbar punc-ture between the third and fourth lum-bar vertebrae. (Keens Surgery.) Fig. 132.—Showing flexed posture ofpatient and point for making lumbar punc-ture, I cm. to the side of the median line,and between the third and fourth lumbarspines. ( Keens Surgery.) highest points of the iliac crests), the linger of the left hand is placedon the spine of the fourth vertebra, and the needle entered about3^^ inch to the right and just below the highest point of the spine,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 individ
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