. 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. aid directly in retaining the anesthetic in situ. The congestion and ecchymosis sometimes seen to follow its actionin the tissues may here, in the loosely supported vessels of the cordand meninges, have a more pronounced effect, which may lead tounpleasant sequelae. SPINAL ANALGESIA AND EPIDURAL INJECTIONS 433 FAILURES They average about 9 per cent., but d
. 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. aid directly in retaining the anesthetic in situ. The congestion and ecchymosis sometimes seen to follow its actionin the tissues may here, in the loosely supported vessels of the cordand meninges, have a more pronounced effect, which may lead tounpleasant sequelae. SPINAL ANALGESIA AND EPIDURAL INJECTIONS 433 FAILURES They average about 9 per cent., but differ greatly with differentoperators. This includes cases of complete failure, partial, incomplete, orunilateral anesthesia, and short or delayed anesthesias. Failures may occur even when every detail of the technic is care-fully carried out and the injection is apparently successful. Many ofthese cases have been attributed to idiosyncrasy on the part of thepatient, but this is hardly likely to be the case, except in a very limitednumber of cases, for if such frequent idiosyncrasies existed we wouldhave more failures from local anesthesia. It is more than likely dueto some technical error made possible by anatomic abnormalities, an. Fig. 131.—Schematic representation of proper and improper kind of needle puncturingmembranes of cord show how use of improper needle may withdraw cerebrospinal fluidby point partially entering membranes, but permits escape of most of injected fluid outsideof membrane. imperfect puncture of the membranes, the lumen of the needle onlypartially entering them, permitting an escape of cerebrospinal fluid,but when the injection is made most of the solution escapes extra-dural^ (Fig. 131), or may have become entangled in the bundles ofthe cauda equina, producing only partial or unilateral anesthesia, dueto the puncture being made too laterally. The agent used may have become inert through oversterilizationor age. The delayed appearance of anesthesia can
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