. Regional anesthesia : its technic and clinical application . ti m yXu—^-p^— J Mr Kl ^. ,.^i« i Bls.,,....^.,—] 11/™^! w >t saptu-no. CDlcbrfrpcsl ,. Anl-tibial n. E,l pl„ n Fig. 302.—The sensory nerve supply of the lower extremities (half-diagrammatic). The anesthesia of the entire lower limb may be realized by two pro-cedures, viz., the paravertebral block of L^ to S^^ or the blocking of thesciatic, external cutaneous, anterior crural, and obturator nerves at theroot of the thigh. The difiiculties encountered in obtaining perfect OPERATIONS ON THE LOWER EXTREMITIES 425
. Regional anesthesia : its technic and clinical application . ti m yXu—^-p^— J Mr Kl ^. ,.^i« i Bls.,,....^.,—] 11/™^! w >t saptu-no. CDlcbrfrpcsl ,. Anl-tibial n. E,l pl„ n Fig. 302.—The sensory nerve supply of the lower extremities (half-diagrammatic). The anesthesia of the entire lower limb may be realized by two pro-cedures, viz., the paravertebral block of L^ to S^^ or the blocking of thesciatic, external cutaneous, anterior crural, and obturator nerves at theroot of the thigh. The difiiculties encountered in obtaining perfect OPERATIONS ON THE LOWER EXTREMITIES 425 anesthesia by these procedures suggest the use of the local or regionalfield-block, as described hereafter. Disarticulation of the hip-Joint arebest performed and high amputation of the thigh best made by meansof spinal anesthesia induced in the fourth lumbar space. REDUCTION OF DISLOCATION OF HIP-JOINT A low spinal anesthesia meets every purpose, but if local anesthesiais resorted to, it is necessary to distribute the solution around the dis-. Fig. 303.—Anesthesia for reduction of posterior dislocation of the hip-joint. Theacetabulum is injected from 1. The needle is inserted at 1 and advanced in the direc-tion of the fingers placed on the tuberosity of the ischium. The head of the femur isreached from 2 in the gluteal region. placed head of the femur and inject the joint cavity, whatever be thetype of dislocation. Quenu was the first to apply this procedure; Braunand others have used it successfully. In the case of a posterior luxation,for instance, the head of the femur is defined by palpation, and a longneedle (No. 5, 10 cm.) is introduced through a point in the glutealregion and advanced toward the displaced bone, around which about20 of the 1 per cent, solution is distributed. The joint cavity rnust now be injected. As Braun justly remarks,the dislocated head of the femur cannot be used as a landmark for 426 REGIONAL ANESTHESIA inserting the needle La
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