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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i. The female urethra is easily anesthetized by a few drops of 5 or10 per cent, novocain on a film of cotton wrapped around an appli-cator, and passed into the urethra for a few minutes. External urethrotomy in the ordinary case is quite easily per-formed under local anesthesia. In the presence of extensive urinary 388 LOCAL ANESTHESIA infiltration it may prove difficult and test the abiKty of any but anexperienced operator under local measures, as the fibrous tissue en-countered under these conditions is difficult of thorough infiltration. If the strictured point is deeply situated the pudic and pudendalnerves had best be blocked, though it is possible to proceed entirelywith infiltration, which is the method preferred. The urethra is first anesthetized, a sound passed, and the stric-tured point located or a guide or filiform passed through it. Infil-tration is commenced in the middle line (Fig. 99), just proximal tothe stricture, and carried well down into the subcutaneous tissues.
Text Appearing After Image:
Fig. 99.—Line of infiltration for external urethrotomy. These are now divided, infiltrating further as we advance, until theurethra is reached, when a little solution injected periurethrallyaround the strictured point will permit its painless division or resec-tion, if not too extensive, with subsequent approximation and sutureof the divided ends of the urethra. In cases in which the stricture is long and tortuous or in whichthere are several, the urethra is incised at the distal end of the stric-ture and its lumen opened by retraction, exposing the stricturedorifice, when under direct guidance of the eye a much larger instru-ment can be passed backward toward the l:)ladder, and the exact course GENITO-URINARY, ANORECTAL, AND GYNECOLOGIC OPERATIONS 389 of the urethra recognized through the tissues, when a long needle canbe passed down in close contact with it and the tissues injected.This is best done on both sides and will permit the free incisionof these parts or their dilatation

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