. 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. internal oblique and transversalis from the edge of the rectus so asto enable the conjoined tendon to be brought down; in case this isnecessary, and the dissection be carried very high, some additionalinfiltration at this point may be needed, and should be made directlyinto the tissues to be dissected. 356 LOCAL ANESTHESIA In the event that the hernia sac
. 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. internal oblique and transversalis from the edge of the rectus so asto enable the conjoined tendon to be brought down; in case this isnecessary, and the dissection be carried very high, some additionalinfiltration at this point may be needed, and should be made directlyinto the tissues to be dissected. 356 LOCAL ANESTHESIA In the event that the hernia sac contains a large amount of intra-abdominal contents that cannot be replaced before operation, this canoften be done, after the sac is freely exposed and liberated and theinternal ring enlarged, by taking the sac up in the hands and resortingto manipulation. If the contents are not readily replaced do notopen the sac too freely at once, as the too long exposure of a largelength of bowel may cause unpleasant intra-abdominal discomfortand some complaint on the part of the patient, but make a small slitnear the neck of the sac and explore its contents with the ringer. Thecontents of these large hernia sacs are, as a rule, mostly omentum,. Fig. 87.—Large irreducible hernia operated on by author under local anesthesia. Saccontained omentum and intestines; large part of omentum was resected. with a small loop of bowel. If much bowel is encountered, it can bereplaced in this way usually without much difficulty, unless the omentum is found hard and fibrous from its long sojourn in thesac it will require resection, but, unless badly damaged, it should notbe sacrificed, as it is an organ of many valuable functions. The exposure of the omentum, never gives rise to any discomfort,and its resection causes no complaint, as it has no sensation; butlarge vessels within it aresensitive, and should first be blocked beforeligation or division. In the case of very large herniae, where
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