. Regional anesthesia : its technic and clinical application . ferred to theparietal peritoneum beyond the anesthetized area. Such partial failuresare due to poor technic. 3. Bilateral Reducible Hernia.—The bilateral block (Fig. 284) is basedon the principles described for unilateral herniotomy (page 387). Thedeep injections are made with a mixture of equal parts of the 1 and cent, solutions; the injection of the cord structures and inguinal ring,with the 1 per cent, solution; the subcutaneous injections, with the cent, solution. The total quantity of solution usually employed is
. Regional anesthesia : its technic and clinical application . ferred to theparietal peritoneum beyond the anesthetized area. Such partial failuresare due to poor technic. 3. Bilateral Reducible Hernia.—The bilateral block (Fig. 284) is basedon the principles described for unilateral herniotomy (page 387). Thedeep injections are made with a mixture of equal parts of the 1 and cent, solutions; the injection of the cord structures and inguinal ring,with the 1 per cent, solution; the subcutaneous injections, with the cent, solution. The total quantity of solution usually employed is200 of the per cent, solution, and 50 of the 1 per cent, solu- 394 REGIONAL ANESTHESIA tion, with 20 drops of adrenalin (1 : 1000) in all. If more solution isrequired for very obese patients, the per cent, is preferable to the1 per cent, solution, and not more than 50 containing 5 drops ofadrenalin solution should be used, thus making a total of 250 of per cent, solution and 50 of the 1 per cent, solution. The opera-. Fig. 284.—Field-block for bilateral reducible iiernia. The technic is the same as forunilateral block: 1, Para-iliac wheal; 2, pubic wheal; 3, subinguinal wheal. tion must be started on the side first injected. The results are identicalwith those obtained from the unilateral block. Intraspinal block (page436) is more easily and quickly accomplished, but the resulting anes-thesia is of much shorter duration, lasting only from one hour to onehour and a half. 4. Irreducible Hernia.—The technic is here different from that OPERATIONS ON THE ABDOMEN 395 emplojed in the case of reducible hernia owing to the distortion of theregion. In Fig. 285, wheals 1, 2, and 3 have exactly the same positionas in the case of reducible hernia: 1 is raised about cm. medial toand above the anterior superior spine of the ilium; 2 lies over the pubicspine unless the deformity of the region renders palpation of that spine
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