Identifier: localregionalane00allerich (find matches)
Title: Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice
Year: 1920 (1920s)
Authors: Allen, Carroll Woolsey, 1874-
Subjects:
Publisher: Philadelphia, Saunders
Contributing Library: University of California Libraries
Digitizing Sponsor: MSN

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around the prostate made through this anesthetized area. The adop-tion of the above method will often be found to solve the difticultiesin reaching an inaccessible prostate. In making the deep injections, should they be made into the GENITO-URINARY, ANORECTAL, AND GYNECOLOGIC OPERATIONS 405 substance of the gland itself no harm will be done, only they are notquite as effective as when injected peripherally between the trueand false sheath; any excess of the solution thrown into the gland inthis way is removed during its enucleation and not absorbed. Fol-lowing these injections a catheter is passed into the bladder. Theenucleation of the gland can now be undertaken by any method pre-ferred by the operator and will be absolutely free from all pain orother discomfort. If the intraurethral method is chosen the passageof the catheter can be omitted until later, but I have always foundits presence a convenient guide to the location of the urethra duringthe different stages of the operation.
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Fig. 105.—A, Gauze pack in position in prostatic wound; B, heavy silk doubledattached to pack; C, end of pack projecting from suprapubic wound. Control of Hemorrhage.—A most striking feature is the absenceof all bleeding, only a few sponges being slightly soiled, the loss ofblood amounting to not more than i or 2 drams at most. There isno blood to swab out of the bladder afterward. The cavity left by the prostate is now packed with a Mikuliczpack. This is done in the following manner: The catheter which has been left in the urethra is now utilizedto draw through the urethra, from the bladder outward, a stout pieceof silk which has been doubled and passed through a plug or pad ofiodoform gauze arranged somewhat cone-shape and about the sizeof the cavity left by the removed gland. The silk thread is long 4o6 LOCAL ANESTHESIA enough to reach beyond the glans penis and when pulled upon drawsthis plug effectively into the cavity, thus insuring against anypossible secondary hemorrhage.

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