. 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. fficientlyremoved from the midline to permit a long needle to be passed downthrough healthy tissue to reach the interval between the ribs. In patients suffering from carbuncles we often have complicatingconstitutional conditions, such as diabetes, nephritis, or profoundsepsis, which contra-indicate the safe employment of a general anes-thesia. In these con
. 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. fficientlyremoved from the midline to permit a long needle to be passed downthrough healthy tissue to reach the interval between the ribs. In patients suffering from carbuncles we often have complicatingconstitutional conditions, such as diabetes, nephritis, or profoundsepsis, which contra-indicate the safe employment of a general anes-thesia. In these conditions local methods should be given the prefer-ence if it is possible to employ them. The nerves of the back are divided into two sets of branches—anterior and posterior. The anterior branches (intercostals) run down-ward and forward. 292 LOCAL ANESTHESIA To block the nerves of the back when to the side of the midline,the procedure is the same as for operations upon the thorax by block-ing the intercostals. If the field is high up in the dorsal region, anadditional wall of anesthesia will be necessary above the field, andshould be made well down to the deep muscles to reach any nervesdescending from above. c 2 -° 2 „ 3be of *-. If over the midline, the procedure, as indicated in Fig. 74, may becarried out on the Hackenbuch plan (see Fig. 19), which may also beused to advantage in any region of the back. In the lumbar region, except close to the spine, the exact pointof the nerve cannot be determined; it is then necessary to create awall of anesthesia in the deep muscles to meet the nerves as they come THE THORAX AND BACK 293 through, having the injections surround the field on its inner andupper parts to meet the nerves as they run downward and for-ward (Fig. 74) in the thorax between the ribs (see Nerve-supplyof Thorax), in the lumbar region between the deep lumbar mus-cles (Fig. 73). The posterior nerves run backward, and are dis-tributed to the soft parts lying on eit
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