. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the abdominal walls is from the six lowerintercostals and the upper branches of the lumbar plexus. (SeeFigs. 74-76). In their course through the abdominal walls thesenerves all lie near the inner wall, the intercostals running betweenthe transversalis and internal oblique to the outer edge of therectus. The lumbar nerves emerge just beneath or through thefiber
. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the abdominal walls is from the six lowerintercostals and the upper branches of the lumbar plexus. (SeeFigs. 74-76). In their course through the abdominal walls thesenerves all lie near the inner wall, the intercostals running betweenthe transversalis and internal oblique to the outer edge of therectus. The lumbar nerves emerge just beneath or through thefibers of the psoas muscle, they then lie on the surface of the quadra-tus lumbarum until they reach the transversalis muscles beneathwhich they pass, after which they pursue the same general courseas the intercostals. At the outer edge of the rectus muscle (linea 346 LOCAL ANESTHESIA semilunares) branches are given off which pass forward throughthe anterior rectal sheath to the subcutaneous tissues, these branchesare always encountered at or near the Unea transversae, though ?r^ crcilcr iplmirlmir jiyphni^m X Clnlia^ \ nt-rvc ^ / iiiUrcoslal n commttnlcans?fercostai nerve Xtf medial crus ofliimb. port, vfdiaphragm ^lumbar nerve i. coccygeal ganglion coccygeal nerve sacml nen-e V plexus sacral plexus Fig. 76.—The abdominal and pelvic portions of the sympathetic trunk. Theanterior abdominal and pelvic walls have been removed, the lumbar plexus exposed byremoval of the psoas major, and the aorta left in situ up to its bifurcation. * = Visceralbranches of the pudendal plexus. (Sobotta and McMurrich.) Others are met with between these points. The main trunks thencontinue their course downward and inward lying on the posteriorrectal sheath just beneath the muscle giving olT its terminal branches THE ABDOMEN 347 in this position, which run forward through the muscle toward theskin. As a general proposition, it may be said that in operations uponany intra-abdominal part a thorough infilt
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