. 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. d now, for a thorough understanding of our subject, beable to account for the pain-conducting nerve-fibers within the cavity. We know that all the abdominal organs are innervated almostexclusively by the sympathetic system, and that all the sympatheticganglia as they lie against the vertebral column, both within the ab-domen and above, receive fibers from
. 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. d now, for a thorough understanding of our subject, beable to account for the pain-conducting nerve-fibers within the cavity. We know that all the abdominal organs are innervated almostexclusively by the sympathetic system, and that all the sympatheticganglia as they lie against the vertebral column, both within the ab-domen and above, receive fibers from the spinal nerves just afteremerging from the vertebral foramina (Figs. 73-75). It has beenimpossible to trace these nerve-fibers to their ultimate distribution-most are soon lost in the intermingling of nerve-fibers of that region,some few have been traced to the mesentery, but could not be followedfurther, as it is impossible by any known methods to distinguishbetween sensory and other nerve-fibers. As all painful impressions THE ABDOMEN 335 must come through the cerebrospinal nerves, it is in fibers supplied bythese communicating branches that we must look for the paths ofthese sensations. l; *>,to,«,x ?»»> lumbar nerve I. i \pa^al \ ! V plexus sacral pttius Fig. 75.—The abdominal and pelvic portions of the sympathetic trunk. Theanterior abdominal and pelvic walls have been removed, the lumbar plexus exposed byremoval of the pscas major, and the aorta left in situ up to its bifurcation. *=Vis-ceral branches of the pudendal plexus. (Sobotta and McMurrich.) An effort has more recently been made to reach these rami com-municantes, and at the same time block the parent trunk by reachingthese nerves just as they emerge from the vertebral foramina; thus, by 336 LOCAL ANESTHESIA a paravertebral injection (by one injection) securing both visceral aswell as parietal anesthesia of the entire distribution of the nerve. Thismethod is spoken of more in detail under this headin
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