. Regional anesthesia : its technic and clinical application . rpendicular to the surface of the skin. But, owing to the curva-ture of the bone and to the deep situation of its upper portion, theneedle should be inchned slightly downward for the puncture of atleast the first two foramina, especially in fat patients. The first fora-men is sometimes so deeply situated that from 6 to 7 cm. of the shaftof the needle disappear before its point touches the bone. The needle,in this case, approaches the posterior surface of the sacrum obliquelywhen it is introduced in a direction perpendicular to the
. Regional anesthesia : its technic and clinical application . rpendicular to the surface of the skin. But, owing to the curva-ture of the bone and to the deep situation of its upper portion, theneedle should be inchned slightly downward for the puncture of atleast the first two foramina, especially in fat patients. The first fora-men is sometimes so deeply situated that from 6 to 7 cm. of the shaftof the needle disappear before its point touches the bone. The needle,in this case, approaches the posterior surface of the sacrum obliquelywhen it is introduced in a direction perpendicular to the surface of the 266 REGIONAL ANESTHESIA skin; so that, if the foramen is sought for in an upward direction, theneedle glides along the bone, thus giving the impression that it is beingadvanced within the foramen. The punctures are all made in the sameplane, viz., that which passes through the row of sacral foramina per-pendicularly to the surface of the skin, and the foramina sought forpreferably inward of that plane, but never outward, since the needle 11 it. Fig. 201.—Transsacral block. Note the direction of the posterior surface of thesacrum in relation to the surface of the skin at the sites of puncture, the depth of theforamina beneath the skin and the direction of the needle for the puncture of eachforamen. is liable to enter the sacro-iliac articulation or pass laterally to thesacrum, according to the height of puncture. A Kttle practice ordi-narily gives an almost accurate tactile sense of the rich fibrous struc-tures overlying the foramen and spreading out, so to speak, in itsimmediate neighborhood. The direction of the needle is slightly changedif the foramen is not reached by a first puncture; but gentleness mustbe used in approaching the bone, so as not to hurt the patient, trauma- BLOCKING OF SPINAL NERVES 267 tize the region by repeated punctures, and damage the pomt of theneedle, which bends to a hook and tears through the tissues while itis withdrawn. This faul
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Keywords: ., bookcentury1900, bookdecade1920, bookidregionalanes, bookyear1922
