. 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. Fig. 31.—Position of patient for Kulenkampff brachial plexus injection. (From Braun.) tablished in from one to three minutes; occasionally, however, itmay require a longer delay, from ten to fifteen minutes; failure toobtain anesthesia by this time usually indicates the need of anotherpuncture, when 5 to 10 of a 4 per cent, solution is used in thesame
. 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. Fig. 31.—Position of patient for Kulenkampff brachial plexus injection. (From Braun.) tablished in from one to three minutes; occasionally, however, itmay require a longer delay, from ten to fifteen minutes; failure toobtain anesthesia by this time usually indicates the need of anotherpuncture, when 5 to 10 of a 4 per cent, solution is used in thesame manner, except that the paresthesia in the extremity does notoccur unless the first injection has gone wide of the mark; should thefirst injection fail, the second is not near so likely to succeed (Fig. 32). In the hands of Kulenkampff and his associates, who injected alarge number of cases in this way, very few failures were recorded. The duration of the anesthesia is from one-half hour to threehours, and is associated with complete muscular relaxation of thepart. 222 LOCAL ANESTHESIA Paraneural Injection Within the Axilla.—The arm is abducted toa right angle, the index-finger of one hand is passed up on the outer --j. Fig. 32.—Areas of distribution of cutaneous nerves (after Toldt), showing effect ofKulenkampff plexus anesthesia: | Anesthesia; + +, hyperesthesia; fj, normalsensation; 1, supraclavicular nerves; 2, circumflex; 3, external cutaneous; 4, musculo-spinal; 5, radial; 6, musculocutaneous; 7, median; 8, radial (terminal branches); 9,lateral cutaneous from second intercostal; 10, musculospiral; 11, ulnar; 12, internalcutaneous; 13, palmar branch of ulnar; 14, dorsal branch of ulnar; 15, palmar branchof ulnar; 16, digital branches of ulnar; 17, digital branches of median. (FromBraun.) side of the fossa, and the brachial artery located and slightly dis-placed downward and inward; a long fine needle is now passed overthe tip of the finger and directed up in the lon
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