. 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. y the injected solution. To Anesthetize the Entire Vaginal Outlet.—This is done by acircumferential injection, as illustrated in Fig. 115, the lower portionas described above. Another crescent-like injection is made fromabove, which meets the lower field, starting preferably over the exter-nal ring of the inguinal canal on each side, making the injectionfairly
. 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. y the injected solution. To Anesthetize the Entire Vaginal Outlet.—This is done by acircumferential injection, as illustrated in Fig. 115, the lower portionas described above. Another crescent-like injection is made fromabove, which meets the lower field, starting preferably over the exter-nal ring of the inguinal canal on each side, making the injectionfairly deep and liberal here to thoroughly block all libers of the ilio-inguinal and genitocrural nerves, as they emerge from this opening tobe distributed to the tissues of the labia majora. 424 LOCAL ANESTHESIA Anterior colporrhaphy is done by pulling down the cervix with avolsellum; at this point on the cervix a Httle infiltration can first bedone before applying the instrument. With the cervix well downand on the stretch the submucous tissues between the cervix andurethral opening are well infiltrated (Fig. ii6), carrying the infiltra-tion well out laterally to permit free exposure of the deep fascia in thesubsequent Fig. ii6.—Area of infiltration for anterior colporrhaphy. (From Braun.) The cervix is anesthetized by drawing it down with a volsellumand making a free submucous infiltration around its neck, at itsjunction with the vaginal vault. In making this injection in frontcare should be exercised not to injure the bladder; the point of thedescent of this organ and its proximity to the vaginal vault had bestbe located beforehand by a sound passed within the bladder. A longfine needle with large syringe is now used, the needle directed up in GENITO-URINARY, ANORECTAL, AND GYNECOLOGIC OPERATIONS 425 the long axis of the cervix on each side, just within the cervical tissues,to a depth of from i to 2 inches, and about )-^ ounce of per cent,novocain injected
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