Paravertebral Anesthesia in Gall-stone Surgery

J. William White, T. Turner Thomas
1914 American Journal of the Medical Sciences  
ascribes the success of paravertebral anesthesia largely to the fact that large quantities of non-toxic novocain with adrenalin can be employed. The fluid is injected in the neighborhood of the spinal ganglia and the intervertebral foramina. It had been considered necessary to inject on both sides in order to obtain sufficient anesthesia for abdominal operations. The method has been employed for operations in the neck, thorax, and abdomen. Francke observed severe collapse in several cases and
more » ... several cases and thought this was due to rapid and wide extension of the anesthetic fluid over the surface of the dura mater. Kappis also observed collapse, but in only mild grade in two out of 30 cases. Jurasz does not believe it is due to an epidural extension of the anesthetic fluid but to a special intolerance of some patients espe¬ cially, to strongly concentrated solution of novocain. He believes that too much demand is made by some surgeons on the tolerance of the body to this substance which is a poison. He recommends its employment in gall-bladder surgery, especially for cases in which general anesthesia is contra-indicated. He employed it in two cases without further anes¬ thesia of the skin or peritoneum and obtained complete anesthesia of the abdominal walls, the peritoneum and right-sided abdominal organs. Operative shock, also, seemed to have been excluded completely. He employed the following technique: With the patient in the left lateral position and the knees drawn up, a small quantity of a 0.5 per cent, novocain in solution is injected subcutaneously in a line about 3 cm. from the spinous processes. Then in this line at the level of the sixth spinous process, a fine long needle is introduced and" made to seek the lower border of the corresponding transverse process. Close under it the needle is passed about 0.5 to 1 cm. deeper in a slightly median direction and is moved about carefully until the patient experiences a pain radiating forward. Then 5 c.c. of the solution are deposited with¬ out changing the position of the needle. The pain ceases completely in a minute. The needle is then allowed to remain in position and a second needle is employed to make a similar injection at the level of the next spinous process. After this injection the first needle is removed and with it a third spinal nerve is injected in the same way, the second needle remaining in position. In this way the necessary number of spinal
doi:10.1097/00000441-191412000-00032 fatcat:y7n4xvgufjaodokcxupgebx5ty