. Regional anesthesia : its technic and clinical application . aneoustissue before the skin is moved. The point of the needle can thus bemade to overlie the upper margin of the rib below or that of the ribabove the punctured intercostal space. It is hardly necessary to point out the impossibility of introducingthe needle into the spine through the intervertebral foramen, when theneedle is inserted at a distance of 4 cm. from the midline of the injecting in the upper thoracic region it occasionally happens,however, that cerebrospinal fluid comes out of the needle, although the BLOCKIN
. Regional anesthesia : its technic and clinical application . aneoustissue before the skin is moved. The point of the needle can thus bemade to overlie the upper margin of the rib below or that of the ribabove the punctured intercostal space. It is hardly necessary to point out the impossibility of introducingthe needle into the spine through the intervertebral foramen, when theneedle is inserted at a distance of 4 cm. from the midline of the injecting in the upper thoracic region it occasionally happens,however, that cerebrospinal fluid comes out of the needle, although the BLOCKING OF SPINAL NERVES 229 impression is that the needle has not been advanced deep enough toreach the subarachnoid space. There is, besides, no sign that the nervehas been approached by the point of the needle on its way through theintervertebral foramen. The only explanation of this condition isan abnormal prolongation of the subarachnoid culdesac accompanyingthe nerve beyond the intervertebral foramen. If the needle is intro- ^5 M UL. cecaal tK intercostal Spiaoas process dorsal vertebra. Fig. 181.—Paravertebral dorsal block. The needle inserted opposite the spinousprocess of D* impinges on the upper margin of the rib below the sixth intercostal spaceand passes below the rib in the direction of the seventh intercostal nerve. duced unattached to the syringe, a reasonable time allowed beforeconnecting it with the syringe, and the aspiration test made and re-newed, there is no risk of making intraspinal injections during theparavertebral manipulations. The flow of cerebrospinal fluid promptsthe immediate gradual withdrawal of the needle until the flow the other hand, it is possible to pass the needle through the liga-menta subflava, while injecting very close to the laminas for laminectomy, 230 REGIONAL ANESTHESIA
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