Transactions of the American Association of Obstetricians and Gynecologists for the year ... . soon as the incision is made. In order to retain the intes-tines within the abdominal cavity in such cases, pressure by gauzepads is necessary. This in turn produces more pain, which increasesthe combative action on the part of the abdominal muscles. Wehave here a vicious circle, which spells failure for the method inpractically every case. The individual who blames local anesthesiaor the mental attitude of the patient for this condition can be classi-fied in only one category by those who know what
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . soon as the incision is made. In order to retain the intes-tines within the abdominal cavity in such cases, pressure by gauzepads is necessary. This in turn produces more pain, which increasesthe combative action on the part of the abdominal muscles. Wehave here a vicious circle, which spells failure for the method inpractically every case. The individual who blames local anesthesiaor the mental attitude of the patient for this condition can be classi-fied in only one category by those who know what the actual causeof the trouble is; and yet this is what one usually observes whenattempts are made to perform laparotomies by this method. The ideal sought is a complete abolition of the reflexes of theabdominal wall, with complete relaxation, and a negative intra- USE OF LOCAL ANESTHESIA. 55 abdominal pressure, like that seen at an autopsy. This is accom-plished by a perfect anesthetization of the line of incision, painlesslyproduced, and gentle vertical retraction of the abdominal Fig. i.—Pneumatic injector for use in introducing local anesthesia. Exposure of the viscera is facilitated by the use of the Trendelen-burg position, lateral tilting, etc. To my mind, the most important point is the careful introduction 56 ROBERT EM5IETT F A R R , of the drug; and it is in the attention to small details that successis achieved. All of the modern text-books or articles on localanesthesia advocate the introduction of the needle at two or more un-anesthetized points on the abdominal wall. This entirely unneces-sary procedure is apt to disturb the patient at the very beginning andto shake his confidence in the operator, which may not be any toogreat at best. On the other hand, if the patient is hurt but once,as in making the first dermal wheal and the future sites for the
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