. Regional anesthesia : its technic and clinical application . ~^^ ...y Fig. 259.—Field-block for simple amputation of the breast. The arrows show the direc-tion of the deep injections beneath the gland. institutions. A certain number of wheals are raised around the breastand at a little distance from it (Fig. 259), and through these whealsdeep injections are made beneath the gland, so as to check the sensorycontribution brought in by the upper thoracic nerves approaching the 340 REGIONAL ANESTHESIA gland from the pectoralis major muscle. For so doing, the gland israised and retracted inward b
. Regional anesthesia : its technic and clinical application . ~^^ ...y Fig. 259.—Field-block for simple amputation of the breast. The arrows show the direc-tion of the deep injections beneath the gland. institutions. A certain number of wheals are raised around the breastand at a little distance from it (Fig. 259), and through these whealsdeep injections are made beneath the gland, so as to check the sensorycontribution brought in by the upper thoracic nerves approaching the 340 REGIONAL ANESTHESIA gland from the pectoralis major muscle. For so doing, the gland israised and retracted inward by the left hand to facilitate the insertionof the needle beneath it (Fig. 260). If the needle encounters resistancein the depth, it means that it has passed into the gland. It should beremoved and reintroduced more backward. The retroglandular tissueoffers no resistance to the point of the needle, since it is composed ofloose connective tissue. Care should be exercised not to pass the needle. Fig. 260.—Manner of holding the breast while injecting beneath the gland. between two ribs into the thoracic ca\aty. It is sufl&cient to make theinjections radially toward the central part of the gland, slowly andsteadily discharging the syringe while the needle is advanced ;is wellas while it is withdrawn. Subcutaneous injections are finally madearound the gland joining all the wheals together, so as to control thenerve supply coming from the lateral and anterior cutaneous branchesof the thoracic nerves and from the supraclavicular branches of thecervical ple-xus. Weak solutions should always be preferred to strong OPERATIONS ON THE THORAX 341 ones, the per cent, solution being used in vatying quantities accord-ing to the weight of the patient or size of the gland. It is customaryto inject from 125 to 150 in the average cases of a moderate-sizedbreast. Light massage helps the diffusion of the anesthetic fluid, andten minutes are allowed before the operation is begun. T
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