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 . M^^ Ski Subcutaneoustissue Fascia andmuscle t ^ Bone Fig. 15.—INIcthod (jf intiitniting se\eral planes of tissue, ineliiding underi_\-ing bone fromtwo points of injection (Braun). tures of the skin. This is illustrated schematically in Figs. 15 and16. In making the injections they should not be too rapidly done, asthe sudden distention of the tissues may cause
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 . M^^ Ski Subcutaneoustissue Fascia andmuscle t ^ Bone Fig. 15.—INIcthod (jf intiitniting se\eral planes of tissue, ineliiding underi_\-ing bone fromtwo points of injection (Braun). tures of the skin. This is illustrated schematically in Figs. 15 and16. In making the injections they should not be too rapidly done, asthe sudden distention of the tissues may cause pain or rupture, ofdeUcate parts. PRINCIPLES OF TECHNIC l8l While it is generally advisable to precede any incision by an in-tradermal infiltration along the proposed Une, this is not invariablynecessary. In cases where extensive dissections are to be under-taken, the massive infiltration of the subcutaneous tissues reachesand anesthetizes the nerves in their course to the skin; an indirectmethod of Fig. i6.—Method of anesthetizing area of bone from two puncture points in surrounding soft parts (Braun). COLD The sedative influence of cold when used alone has already beenmentioned. Here a brief reference will be made to its intensifyingeffects upon the anesthetic solutions. Experimentation led to the information that cold solutions ex-erted a more pronounced effect than those used at body tempera-ture, but when injected cold they excited pain in proportion to thelowness of their temperature; it was accordingly recommended thatthey be injected at ordinary temperature and the area then cooled;this was done by packing it in ice or by the use of sterile bags filledwith ice; this refrigeration of the injected area was practised someyears ago, but is now rarely ever employed. Ethyl chlorid spray Wasalso used upon the surface to produce this refrigeration. To favor l82 LOCAL ANESTHESIA the diffusion of the anesthetic solutions they were often injected warmand the cold
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