. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. Fig. 89.—Method of injection around umbilical hernia. (From Braun.) anesthesia, nevertheless it can be performed; but in thin or moder-ately stout patients, unless the condition is very severe, it can bequite satisfactorily performed. HERNIA 361 In all these operations the mechanical difficulties are very muchlessened by putting the patient to bed for a fe
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. Fig. 89.—Method of injection around umbilical hernia. (From Braun.) anesthesia, nevertheless it can be performed; but in thin or moder-ately stout patients, unless the condition is very severe, it can bequite satisfactorily performed. HERNIA 361 In all these operations the mechanical difficulties are very muchlessened by putting the patient to bed for a few days, on restricteddiet, with daily laxatives. This relaxes the abdominal walls andrelieves the intra-abdominal tension, and approximation of the gapcan be much more easily obtained. With Solution No. 1 several stations in the skin are anesthetized;if the hernia is small, one on each side; if large, one above and onebelow, in the median line, in addition (Figs. 89, 90). By entering atthese points (Matas infiltration apparatus or large syringe with longneedle) and passing the needle in all directions, a circumferential in-jection is made into all the subcutaneous tissues, thus creating a zone. Fig. go.—Cross-section through umbilical hernia, showing method of making deep in-jections through abdominal walls. (From Braun.) of anesthesia. If the underlying muscles are clearly outlined, andthere is no danger of going through them, these may be infiltratedat the same time; otherwise this had better be delayed until they areexposed. After a delay of from ten to fifteen minutes, to allow thesolution time to diffuse, the incision can be made. First, expose themuscles and thoroughly infiltrate them down to the peritoneum, ifthis has not already been done. While we are waiting for the lastinjection to diffuse, bleeding points can be ligated and the sac openedand its contents dealt with. By now the parietal peritoneum willprobably have become anesthetized, and the sac can be cut away
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