. Regional anesthesia : its technic and clinical application . the operative field; but, as already stated, the occasionalfailures to produce anesthesia by means of caudal block alone and theslowness with which the anesthesia sets in, suggested the use of itsassociation with transsacral block. Sacral block induced in the same manner as for external urethrotomy(page 413) is the procedure actually recommended for hemorrhoidec-tomy, as well as for fissures in ano, rectal prolapse, and rectal pol>-p. POSTERIOR RESECTION OF THE RECTUM Control of the psychic element of the patient is here of the
. Regional anesthesia : its technic and clinical application . the operative field; but, as already stated, the occasionalfailures to produce anesthesia by means of caudal block alone and theslowness with which the anesthesia sets in, suggested the use of itsassociation with transsacral block. Sacral block induced in the same manner as for external urethrotomy(page 413) is the procedure actually recommended for hemorrhoidec-tomy, as well as for fissures in ano, rectal prolapse, and rectal pol>-p. POSTERIOR RESECTION OF THE RECTUM Control of the psychic element of the patient is here of the highestimportance. For a single-stage Kraske operation the usual hjpodermicinjection of morphin i gr. and scopolamin sxru gr. is given one hourbefoie the anesthesia is begun, and a second dose of the same strenghtinjected immediately after the completion of the anesthesia. Indi- GENITO-URINAEY AND RECTAL OPERATIONS 415 vidual cases must, however, be considered in administering two dosesof the combined narcotics (page 12), since these drugs are used to enable. Fig. 298.—Sacral block and paravertebral block of the last three lumbar nerves: 1 to 5,Transsacral block; 6 to 8, paravertebral lumbar block. the patient to feel more comfortable in that rather awkward positionhe must assume during the operation. For the colostomy in the two-stage operation one injection of morphin-scopolamin is, as a rule, 4l6 REGIONAL ANESTHESIA sufficient to dull the mentality of the patient, provided it is given onehour before the anesthesia is begun, and the colostomy is performedten minutes after the anesthesia has been completed. In very nervouspatients a second dose is given at the time of the anesthesia if the firstdose does not seem to have produced the desired effect. The patient isprepared for the second-stage Kraske in the same manner as for thesingle-stage operation. Anesthesia for the colostomy is induced in the manner describedon page 373 for right rectus colostomy or sigmoidostomy. For t
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