. 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. the plane of tissues andthere is less danger of the needle puncturing the rectum. Having made the midline injection, the needle is partially with-drawn and directed slightly laterally and upward on first one sideand then the other, using in each an additional 5 or 10 , dependingupon the extent of the field. Similarly, a third or fourth injection GENITO-URIN
. 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. the plane of tissues andthere is less danger of the needle puncturing the rectum. Having made the midline injection, the needle is partially with-drawn and directed slightly laterally and upward on first one sideand then the other, using in each an additional 5 or 10 , dependingupon the extent of the field. Similarly, a third or fourth injection GENITO-URINARY, ANORECTAL, AND GYNECOLOGIC OPERATIONS 423 can be made just lateral to the preceding, until i)ractically the entirevaginal canal except the roof has been infiltrated. A crescentic-likeinjection, made subcutaneously with the long needle around thevaginal outlet and carried upon each side the full extent of the field,completes the anesthetizing process. If a perineorrhaphy is to be done, and the tear involves the sphinc-ter, the anal canal must then be anesthetized, as described in that sec-tion. The above method of injection gives a perfect anesthesia andis very quickly done after a little practice, and the latter steps of the. Fig. 115.—For anesthesia of vaginal outlet, including labia majora. (From Braun.) operation, if for perineorrhaphy, much facilitated through the sepa-ration of the different planes of tissues by 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 ANESTH
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