. 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. nces ofdiffusion helped by oscillation. Personally, I have never aimed atgetting a higher analgesia than to the transverse nipple line. At thecaudal curve the effects of a heavy compound can be limited in the SPINAL ANALGESIA AND EPIDURAL INJECTIONS 419 same way by position. If the patient be seated on the edge of theoperating-table, with his feet on a low
. 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. nces ofdiffusion helped by oscillation. Personally, I have never aimed atgetting a higher analgesia than to the transverse nipple line. At thecaudal curve the effects of a heavy compound can be limited in the SPINAL ANALGESIA AND EPIDURAL INJECTIONS 419 same way by position. If the patient be seated on the edge of theoperating-table, with his feet on a low chair and his back rounded,the heavy fluid injected at the second lumbar interspace at oncetends to run into the sacral dura, as we see also in our tube experi-ments. Here it accumulates at the end of the dural sac, where itquickly affects the roots of the nerves supplying the parts about theanus and the perineum. This is seen so constantly, even where anal-gesia is less satisfactory in other parts, that it suggests that whenthe injection is made in the sitting position most of it makes its waycaudally, and it requires much and immediate elevation of the pelvisand oscillation of the cerebrospinal fluid to dislodge it from the sacral. Fig. 122.—Photograph of the same patient gently rolled over on the back with the samerelations of head, neck, and pelvis. The line across the fourth lumbar spine is seen, and alsothat the dorsal curve is deeper than the previous lateral curve. From a photograph byDr. E. Worrall. (Barker, in Brit. Med. Jour.) sac. That is why I have thought it well in some cases to puncturewith the patient lying face downward, with a hard pillow crosswiseunder the umbilicus, so as to decrease the lumbar curve. In thisposition a heavy fluid runs toward the head, and if after half a min-ute the patient roll over on the back and have a pillow placed underthe head and neck pretty high, the injected fluid collects in the lowerdorsal curve. This prone position, otherwi
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