. Regional anesthesia : its technic and clinical application . rough the wheal and advanced transverselytoward the bone which is met after piercing the peroneus longus no paresthesias are induced by the first puncture, the solution isdistributed fanwise in close contact with the bone, on a length of about 296 REGIONAL ANESTHESIA 5 cm. using 5 of the 2 per cent, solution. In case the nerve is hit,the injection is made, as usual, without displacing the needle. Indications.—^Associated with the garter (page 316) the externalpopliteal block is indicated for operations on the anterol
. Regional anesthesia : its technic and clinical application . rough the wheal and advanced transverselytoward the bone which is met after piercing the peroneus longus no paresthesias are induced by the first puncture, the solution isdistributed fanwise in close contact with the bone, on a length of about 296 REGIONAL ANESTHESIA 5 cm. using 5 of the 2 per cent, solution. In case the nerve is hit,the injection is made, as usual, without displacing the needle. Indications.—^Associated with the garter (page 316) the externalpopliteal block is indicated for operations on the anterolateral regionof the leg, the anterior aspect of the ankle, and the dorsum of the foot;but the anesthesia does not extend to the lateral margin of the foot,partly innervated by the saphenous nerve which receives contributionsfrom the internal popliteal nerve. ANTERIOR TIBIAL BLOCK (Blocking of the Anterior Tibial Nerve) The patient lies on his back, with the lower extremity on the sideto be injected flexed, so that the sole of the foot may rest on the table. Fig. 219.—.terior tibial block. as near its edge as possible (Fig. 219). A line is drawn around theankle at the base of the internal malleolus and a wheal raised on thisline on the lateral margin of the tendon of the tibiaHs anticus. NeedleNo. 2 (5 cm.), connected with the syringe, held like a penholder, is intro- BLOCKING OF SPINAL NERVES 297 duced through the wheal and advanced in a sagittal direction until itspoint impinges on the tibia. The needle is drawn backward about2 mm. and injection made of 5 of the 1 per cent, solution, withoutmoving, while the point of the needle still Hes between the deep fasciaand the bone. As already seen (page 286), the anterior tibial nerve approaches theankle in a direction slightly inclined downward and outward; so that ithas, at the ankle, positions which vary with the level considered andadopted by the operator. The anterior tibial nerve may, therefore,occupy one of the three f
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