. Regional anesthesia : its technic and clinical application . Fig. 253.—Field-block of the four fingers and part of the palmar region: 1 and Sthe margins of the hand, toward its dorsal aspect. (a) Intradermal wheals are always raised on the dorsum of thehand, and the needle advanced toward the palmar region by passing 332 REGIONAL ANESTHESIA through the interosseous spaces or around the margins of the hand. Thepalm is never punctured for the purposes of anesthesia. {b) The operator holds the patients hand with his left hand in sucha way that one of his fingers may control the position of the
. Regional anesthesia : its technic and clinical application . Fig. 253.—Field-block of the four fingers and part of the palmar region: 1 and Sthe margins of the hand, toward its dorsal aspect. (a) Intradermal wheals are always raised on the dorsum of thehand, and the needle advanced toward the palmar region by passing 332 REGIONAL ANESTHESIA through the interosseous spaces or around the margins of the hand. Thepalm is never punctured for the purposes of anesthesia. {b) The operator holds the patients hand with his left hand in sucha way that one of his fingers may control the position of the point of theneedle beneath the skin of the palm. (c) Small quantities of the 1 per cent, solution are preferred to largequantities of the per cent, solution, so as to avoid prolonged anemia. Fig. 254.—Field-block of portions of the dorsal aspect of the hand,with consequent sloughing. For the ring, 3 of the 2 per cent, solu-tion are better than 5 of the 1 per cent, solution. (d) The injected area must be massaged to facilitate the diffusionof the anesthetic fluid. (e) The tip of the finger must be insensitive to painful stimuli beforethe operation is begun. (/) Infection of the diffuse phlegmonous tjpe contraindicates theuse of the local procedures. Nerve-block must be resorted to andinduced at the greatest possible distance from the focus of infection. CHAPTER VIII OPERATIONS ON THE THORAX All operations involving the skin and superficial fascia are madeby field-blocking, that is, by subcutaneous infiltration around the lesion;for instance, for excision of a lipoma wheals are infiltrated around thetmnor and at a little distance from it and subcutaneous injections withthe per cent, solution made along the lines joining the wheals to-gether. The needle is th
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