. Regional anesthesia : its technic and clinical application . Fig. 26.—Costal margin block. The shaded area represents the anesthesia obtainedafter infiltrating along the costal margin only. If the operative manipulation is ex-tended to the midline, or in case of a postoperative hernia in the shaded region, it isnecessary to infiltrate subcutaneously along the midline, as illustrated. The dotsrepresent wheals. ways: (1) By intraneural injection, which may be performed eitherafter exposing the nerve and depositing the solution within thenerve sheath, or by injecting the solution within the ner
. Regional anesthesia : its technic and clinical application . Fig. 26.—Costal margin block. The shaded area represents the anesthesia obtainedafter infiltrating along the costal margin only. If the operative manipulation is ex-tended to the midline, or in case of a postoperative hernia in the shaded region, it isnecessary to infiltrate subcutaneously along the midline, as illustrated. The dotsrepresent wheals. ways: (1) By intraneural injection, which may be performed eitherafter exposing the nerve and depositing the solution within thenerve sheath, or by injecting the solution within the nerve sheath bymeans of a needle introduced through the soft tissues overlying the S4 REGIONAL ANESTHESIA nerve. (2) By extraneural or paraneural injection, which consistsin depositing the solution in close proximity to the nerve, which is thusreached only by diffusion. Intraneural injections are not advised forsurgical purposes. The exposure of a nerve is already a surgical act of. Fig. 27.—Costo-iliac block. The shaded area represents the anesthesia resultingfrom the infiltration of a wall extended from the tip of the eleventh rib to the anteriorsuperior iliac spine (*). The dots represent the wheals. greater importance than the simple injection of the nerve from the anesthesia produced by intraneural injections is instan-taneous in most cases, this procedure is occasionally followed by post-operative neuralgia. Extraneural injections are not painful, while GENERAL PRINCIPLES OF TECHNIC 55 intraneural injections produce shock, especially when they are repeatedon several large trunks. They give as good anesthetic results, providedthe solution is not injected too far from the nerve and the correctstrength of solution used. It is hardly necessary to wait more than
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