. 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. found this procedure of value in 9 cases. On several occasions,because of the various seemingly urgent reasons involving the safetyof the patient, we deemed it advisable to convert a thyroidectomyinto a ligation of vessels. For the ligation of the superior thyroid arteries the area of thesuperficial anesthesia is shown in Fig. 65. After the
. 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. found this procedure of value in 9 cases. On several occasions,because of the various seemingly urgent reasons involving the safetyof the patient, we deemed it advisable to convert a thyroidectomyinto a ligation of vessels. For the ligation of the superior thyroid arteries the area of thesuperficial anesthesia is shown in Fig. 65. After the skin has been 28o LOCAL ANESTHESIA passed, deeper injections are made into the parts before their dissec-tion, making these injections rather liberally around the superiorpoles, which must be well blocked before being ligated. In the preceding pages I have endeavored to point out some of theuses of local anesthesia in the major surgery of the neck. It is onlyfair now to state that there still remains conditions in which it is animpracticable and unsatisfactory mode of anesthesia. This is par-ticularly true of all atypical operations in which the lesions and thelimits of the field of operation are ill-defined, as in multiple lymphatic. Fig. 65.—Line of infiltration anesthesia for double ligation of superior laryngeal each side the injection is made freely into the deep tissues. tuberculosis, where the chains of infected glands are held fast to theperiglandular tissues by dense adhesions. In the removal of chains oi malignant lymph-nodes the sameobjections hold with still greater force, and a general anestheticbecomes necessary. Malignant tumors, unless well defined, shouldrarely if ever be operated upon by infiltration in any region, and whendone the Hackenbuch plan should be followed. These remarks donot refer to the application of regional methods for this purpose, whichcan always be employed. CHAPTER XVI THE THORAX AND BACK In the major surgery of this region the
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