Transactions of the American Association of Obstetricians and Gynecologists for the year ... . al anesthesia. TECHNIC. In all of my abdominal work, except in the operation for inguinalhernia, a direct infiltration of the tissues is effected and the completeinfiltration of the abdominal wall is made before the incision is be-gun (Fig. 4). This method is chosen because of its efficiency,simplicity, accuracy, and speed. This direct method is not used 58 ROBERT EMMETT FARR, in the case of inguinal hernia because the infiltration of the tissuesobscures, to some extent, their anatomical relations. V
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . al anesthesia. TECHNIC. In all of my abdominal work, except in the operation for inguinalhernia, a direct infiltration of the tissues is effected and the completeinfiltration of the abdominal wall is made before the incision is be-gun (Fig. 4). This method is chosen because of its efficiency,simplicity, accuracy, and speed. This direct method is not used 58 ROBERT EMMETT FARR, in the case of inguinal hernia because the infiltration of the tissuesobscures, to some extent, their anatomical relations. Visiting surgeons frequently inquire regarding the danger of in-troducing the needle directly through the abdominal wall and in-juring the abdominal viscera. This danger is practically nil, as hasbeen proved in thousands of instances in human as well as animalsurgery. If the needle is advanced slowly, and a stream of the solu-tion is constantly forced ahead of the needle point, the peritoneumwill seldom be penetrated. This point has been proved by usingsolutions colored with methylene p1G a—Section of abdominal wall, showing area infiltrated. Once the abdomen is open, vertical retraction, tilting, and carefulmanipulation of the tissues are the main strategic points. Sensitivevisceral surfaces, such as are found in the round ligaments, themesoappendix, about the uterine cervix, the ovarian pedicles, andthe cystic duct of the gall-bladder may be anesthetized before beingattacked. Long, fine needles, mounted upon the ball-and-socketjoint of the cut-off as shown in Fig. 5, should be used where one USE OF LOCAL ANESTHESIA. 59 wishes to make infiltrations deep within the abdomen and the handdoes not obscure the view. Suction is substituted for sponging,which may cause a disagreeable sensation. Where traction on thepelvic viscera is anticipated, as in the case of bad infections or malig-nancy, caudal anesthesia precedes the infiltration of the abdominalwall. Vicious, forcible
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