. 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. llowed the general introductionof the method has been followed by a reaction, and we find, upon thestudy of the large number of statistics which are now available, thatthe method cannot compare in safety at the present stage of its devel-opment with general anesthesia. If it is to compete with generalanesthesia it must be by the introduction of some other
. 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. llowed the general introductionof the method has been followed by a reaction, and we find, upon thestudy of the large number of statistics which are now available, thatthe method cannot compare in safety at the present stage of its devel-opment with general anesthesia. If it is to compete with generalanesthesia it must be by the introduction of some other agents ormethods than those now in use. It has, however, a decided field of usefulness in selected cases andunder certain conditions. A thorough understanding of spinal anesthesia is not possiblewithout the consideration of certain anatomic, mechanical, and physio-logic facts. 406 LOCAL ANESTHESIA ANATOMY The spinal cord ends opposite the lower border of the first lumbarvertebra (in the child, opposite the third lumbar), in the filum termi-nalis, which is given off from the conus terminalis (Fig. 115). The spinal cord and cauda equina are surrounded by the samemembranes as the brain—viz., dura, arachnoid, and pia. spinal dura maltr. jitam terminate s/iinal dura mater Fig. 115.—An anterior view of the lower portion of the spinal cord. The dura mater hasbeen divided longitudinally. (Sobotta and McMurrich.) The dura, continuous with that which invests the brain, is a loosesheath, not attached to the bony framework of the spinal canal, butseparated from it by loose areolar tissue containing a plexus of veinswhich are most numerous in front and on the sides, less so dural sac terminates at the third sacral segment. It is attached SPINAL ANALGESIA AND EPIDURAL INJECTIONS 407 by fibrous slips to the posterior common ligament, and is largestin the cervical and lumbar regions. At the beginning of the caudaequina the nerves lie in bundles on each side, with an appreci
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