. Regional anesthesia : its technic and clinical application . ance of theneedle for the injection of the soft structures in the direction of the arrows; a, the siteof puncture for instillation into the laryngeal cavity. upward and downward on the mucosa. The circumferential infiltrationor field-block takes about 30 of the per cent, novocain-adrenalinsolution, while the intratracheal instillations require only 2 of a10 per cent, cocain solution. Ten minutes are allowed for the anesthesiato set in. Total Laryngectomy.—As a rule, a preliminary tracheotomy hasbeen performed a fortni
. Regional anesthesia : its technic and clinical application . ance of theneedle for the injection of the soft structures in the direction of the arrows; a, the siteof puncture for instillation into the laryngeal cavity. upward and downward on the mucosa. The circumferential infiltrationor field-block takes about 30 of the per cent, novocain-adrenalinsolution, while the intratracheal instillations require only 2 of a10 per cent, cocain solution. Ten minutes are allowed for the anesthesiato set in. Total Laryngectomy.—As a rule, a preliminary tracheotomy hasbeen performed a fortnight before. The second-stage operation isperformed under regional anesthesia induced in the following manner: OPERATIONS ON THE NECK 307 (a) The cendcal plexus block (page 174) is performed on both sides. {b) With the patient lying on his back and a cushion slipped underthe shoulders so as to place the head in extension, a horseshoe infiltra-tion is made subcutaneously along B-2-\-2-B (Fig. 228) with 20 the per cent, novocain-adrenalin Fig. 228.—Regional block for total laryngectomy: B, B, Cervical plexus block; A,superior and inferior laryngeal block; B~2-l-2-B, subcutaneous infiltration. Thehypopharjnx is anesthetized through A. (c) The superior and inferior laryngeal nerves are blocked througha single point of entrance A (Fig. 228), according to the technic de-scribed on pages 112-117. (d) The anesthesia of the h^-pophar^-nx (Fig. 229) is obtained byintroducing the needle through the thyrohyoid membrane, using the 3o8 REGIONAL ANESTHESIA same point of entrance A, and instilling drop by drop 2 of a 10 percent, cocain solution (Canuyt). (e) The anesthesia of the trachea is performed by swabbing themucous membrane with a 10 per cent, cocain solution applied throughthe tracheal opening. (f) After preliminary rhinoscopic examination as to the perme-ability of the nasal cavities, one of them is anesthetized by means ofan appUcator moistened with a 10
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