. Anesthésie régionale : son application technique et clinique . pendant les manœuvres chirurgicales.son association avec l'analgésie splanchnique (page 358) élargit les possibilités chirurgicales de la procédure. La libération d'une annexe adhérente ou rétro-caecale peut donc être accomplie sans douleur. Pour l'appendectomie dans le stade aigu de la maladie intraspinalblock (anesthésie rachidienne) est la procédure de choix, en raison de thereslating silence abdominal qui établit des conditions opératoires favorables et postopératoires. Les abcès sont drainés par infiltration loquementle long de la ligne d'incision. FOUGÈRE OMBILICAL

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. Regional anesthesia : its technic and clinical application . during the surgical maneuvers.Its association with splanchnic analgesia (page 358) widens the surgicalpossibilities of the procedure. The liberation of an adherent or retro-cecal appendix can thus be painlessly accomplished. For appendectomy in the acute stage of the disease intraspinalblock (spinal anesthesia) is the procedure of choice, because of theresulting abdominal silence which establishes favorable operative andpostoperative conditions. Abscesses are drained by infiltrating locallyalong the line of incision. UMBILICAL HERNIOTOMY The abdominal field-block is the procedure usually employed forumbilical herniotomy. It is the procedure of choice, whatever be thevolume of the hernia or the weight of the patient. Strangulation is 382 REGIONAL ANESTHESIA not a contraindication to the method of regional anesthesia; on thecontrary, it is imperative. With the patient lying on his back, wheals are raised as illustratedin Fig. 275, and through each of these wheals a needle of convenient. Fig. 275.—Field-block for umbilical herniotomy. The lateral rows of wheals(2-3-4 and 5-6-7) are here raised beyond the lateral margin of the recti muscles owingto the size of the hernia; ^.5.5. is the anterior superior iliac spine. length, connected with the syringe filled with the 0.5 per cent, solution, is passed and advanced toward the muscle layer within which thesolution is distributed fanwise as usual. Subcutaneous injections arethen made joining all the wheals together except the two lowest. Thenerve supply of the enclosed area is thus cut ofT, including that of the OPERATIONS ON THE ABDOMEN 383 corresponding portion of the parietal peritoneum, thus making it possi-ble to manipulate the neck of the sac and liberate extensive intestinaladhesions without causing pain. Resection of the adherent omentumis not painful. If the lateral rows of wheals are raised still more laterally, it ispossible to make a long transverse

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