. Anesthésie régionale : son application technique et clinique . sur de tels symptômes toxiques il est advisableto faire des injections paravertébrales à une distance d'environ 1 cm. De la thespine, et surtout, pour s'assurer que l'injection n'est pas faite dans le flux sanguin. Anesthésie.—l'anesthésie suivant l'injection du seul nerf onéthoracique est illusoire, puisque les branches cutanées des nerfs contigeurschevauchent l'espace intercostal fourni par ce nerf; et, sans compter, le liquide anesthésique est distribué par voie sous-cutanée le long de l'espace intercostalinal, ou injection faite d'au moins un nerf au-dessus et un

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. Regional anesthesia : its technic and clinical application . on of such toxic symptoms it is advisableto make paravertebral injections at a distance of about 1 cm. from thespine, and, above all, to make sure that the injection is not made intothe blood-stream. Anesthesia.—The anesthesia following the injection of only onethoracic nerve is illusory, since the cutaneous branches of the adjacentnerves overlap the intercostal space supplied by that nerve; and unlessthe anesthetic fluid is distributed subcutaneously along the intercostalspace, or injection made of at least one nerve above and one nerve belowthat space, there will always be pain or tenderness. Besides, the dorsalbranches of the thoracic nerves supplying the skin slope downward andoutward, overlapping at times adjacent territories, and it occasionally BLOCKING OF SPINAL NERVES 233 happens that these branches are not reached by the paravertebral in-jections made in the usual manner. To make sure that they are theactual cause of pain or tenderness in a region where the injections made. Fig. 183 —Distribution of the sensory nerves of the trunk A, Hypesthesia due to thecervical nerves B, territory of the dorsal nerves C, that of the lumbar nerves. were expected to produce absolute anesthesia, a transverse subcutaneousline of infiltration is made through the uppermost site of puncture usedfor the paravertebral injections and the region tested again 234 REGIONAL ANESTHESIA In front, the anesthesia produced by paravertebral injections doesnot extend to the midline, but stops at about an inch from it, thusleaving a narrow band of hypesthesia due to overlapping nerve fila-ments from the opposite side. It is sufficient to distribute the solutionsubcutaneously along the midline to complete the anesthesia. In the upper thoracic region the superficial cervical nerves overlapthe territory of the first three or four dorsal nerves (Fig. 183), and givea zone of hypesthesia which can easily be controlled by subcutaneo

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