. 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. Fig. 144.—Direction of long needle for parasacral injections. (From Braun.) ward inclination, that it will pass directly over the fourth, third, andsecond foramina, when, after meeting the bone above this opening, PARAVERTEBRAL AND PARASACRAL ANESTHESIA 505 if it will be slightly withdrawn and redirected, with the point elevated1^ inch and advanced i inch furt
. 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. Fig. 144.—Direction of long needle for parasacral injections. (From Braun.) ward inclination, that it will pass directly over the fourth, third, andsecond foramina, when, after meeting the bone above this opening, PARAVERTEBRAL AND PARASACRAL ANESTHESIA 505 if it will be slightly withdrawn and redirected, with the point elevated1^ inch and advanced i inch further, that it will reach the first sacralforamina (Figs. 143, 144). It is seen, after a study of numerous sacrums, that the interme- lateral sacral artery bimboiacral trunk. f. epigastric art. \ \ sacr. nerves tV \ middle haemorrhoidalnerves \i Coccygeus\ coccygeal nerve •sacrospin. ^Pudendal plexuslig. X internal pudie art. X middle haemorrhoidal art. X pudic nerve infer. Fig. 145.—The blood-vessels and nerves on the right pelvic wall. The pelvis hasbeen halved by a sagittal section and the genitalia removed. X = Branches to thecoccygeus. X X = Branch to levator ani. + = Site of abdominal inguinal ring.+ + = Branches to pyriformis. (Sobotta and McMurrich.) diate foramina between the fourth and first in some few are placedsomewhat outside of the straight line, passing over the center of theopenings; this lateral variation is usually about % inch, and wasnever seen to exceed )-^ inch. 5o6 LOCAL ANESTHESIA As the nerves, as they emerge from the foramina run downward,outward, and forward (Fig. 145), it would seem best to sHghtlyincrease the lateral angle of the needle, so that at a depth of about2 inches its point will be about }/i inch lateral to the
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