. 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. ) in close contact with it; some opera-tors inject within the cord in this way. but I find it better not to do so,as a vein might be injured, and, while of no consequence, it mightproduce a hematoma or discolor the field with blood, and as thecord is to be later exposed nothing is gained. The incision is then 392 LOCAL ANESTHESIA made through the anesthetized
. 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. ) in close contact with it; some opera-tors inject within the cord in this way. but I find it better not to do so,as a vein might be injured, and, while of no consequence, it mightproduce a hematoma or discolor the field with blood, and as thecord is to be later exposed nothing is gained. The incision is then 392 LOCAL ANESTHESIA made through the anesthetized skin and fascia down to the cremas-teric fascia; this is divided and the cord freely exposed and drawn outof the wound; the deep injections previously made around the cordpermit this manipulation without discomfort. With the cord nowfreely exposed out of the wound it can be thoroughly injected withthe small syringe; the genitocrural nerve lies at the back of the cordnear the vas, but all veins should also have a wall of anesthesia aroundthem, as they are sensitive. These injections are all made high upat the proximal end of the field. Having completed this procedure,the entire scrotal contents are anesthetic, and any contemplated. Fig. I02.—Method of infiltrating around spermatic cord. operation can be performed. The testicle can be drawn out of thescrotum and freely exposed to view, but traction should not be madeupon the upper end of the cord, as this pulls upon the unanesthetizedparts above and will produce pain. If the condition is one of varicocele, the veins of the entire cordand about the epididymis can be resected. If for hydrocele, the inversion operation or the removal of theparietal portion of the tunic, as in the Volkmann operation, can beperformed with equal satisfaction. In the event of inflammation creating adhesions within the scro- GENITO-URINARY, ANORECTAL, AND GYNECOLOGIC OPERATIONS 393 turn, these may have to be infiltrated before the sac can be dissecteda
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