. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. favor its diffusion 238 LOCAL ANESTHESIA (Corning, Tito-Costa, Hackenbuch). After the constrictor had beenapplied and the limb has assumed a cadaveric appearance, the ap-plication of ice-cold water, or ethyl chlorid spray, for a few minutes tothe finger will hasten and greatly intensify the anesthetic effect. Thisis particularly true of acute inflammatory
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. favor its diffusion 238 LOCAL ANESTHESIA (Corning, Tito-Costa, Hackenbuch). After the constrictor had beenapplied and the limb has assumed a cadaveric appearance, the ap-plication of ice-cold water, or ethyl chlorid spray, for a few minutes tothe finger will hasten and greatly intensify the anesthetic effect. Thisis particularly true of acute inflammatory conditions, which are themost rebellious to local anesthetic influences. If the anesthesia isretarded we should be in no hurry to add more anesthetic. The bestplan is to relax the constrictor, allow the circulation to return, anddiffuse the anesthetic for half a minute, and again exsanguinate andconstrict the digit. The elastic constrictor combined with exsanguina-tion is not only valuable in prolonging the anesthesia indefinitely, butit helps to intensify it as well. In fact, it is possible by simple ex-sanguination and prolonged elastic compression at the root of thefinger and limbs to produce a degree of anesthesia which is itself. Fig. 40.—Areas of digital anesthesia resulting from tranverse subcutaneous infil-tration on dorsal and palmar surfaces. Compare with nerve distribution, shown inFig. 41. (From Braun.) compatible with the painless performance of small and superficialoperations. (This fact, long ago utilized by James Moore, 1784, andby Hunter, has been especially insisted upon in recent times by Corn-ing, Kauffman, Kummer, and every surgeon who has had experiencewith it.) The paraneural method which we have described is simplya regional application of Comings principles (1885) (Matas). In Germany it is known as Obersts method, the only differencebetween his method and Obersts consisting in the fact that Oberstapplies the constrictor first; it is also referred to b
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