. 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. operation. They should notbe given where local or regional anesthetics are at all practicable. TECHNIC About one hour before the administration of spinal puncture it isadvisable to give a hypodermic of a small dose of morphin (f or J gr.).Many observers prefer the combination of morphin and scopolamin, 424 LOCAL ANESTHESIA as recommended by the writer, bef
. 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. operation. They should notbe given where local or regional anesthetics are at all practicable. TECHNIC About one hour before the administration of spinal puncture it isadvisable to give a hypodermic of a small dose of morphin (f or J gr.).Many observers prefer the combination of morphin and scopolamin, 424 LOCAL ANESTHESIA as recommended by the writer, before major operations under localanesthesia. By this method the bad after-effects are much lessenedand the analgesic effect much intensified and prolonged. The doseshould never be large enough to produce somnolence, but just suffi-cient to allay the fears and anxiety of the patient by inducing drowsi-ness and indifference. Morphin, gr. £or \, with scopolamin, gr. ,-|¥,is the dose recommended by the writer. Under this influence thefear and psychic influences which may contribute to shock are greatlylessened or entirely eliminated. This is particularly useful in nervouspatients and in all patients for amphitheater work. Coming before. bar R/rrc tore. Fig. 124.—The point for lumbar puncture. (Keens Surgery.) large crowds, and being operated in the conscious state, is bound tohave some disturbing effect even upon the most stoical. Dr. Fowler has recommended TV gr. of strychnin a quarter of anhour before the puncture, stating that it lessens shock, respiratory,and circulatory disturbances. While this method is theoreticallygood, it does not seem to have found much favor, and it would seembetter to use the morphin and scopolamin as above suggested. Theiraction in allaying nervousness and excitement in the patient, andthus arresting psychic influences, operate more toward lesseningshock than stimulation of the centers with strychnin. SPINAL ANALGESIA AND EPIDURAL INJECTIONS 425 Thi
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