The practical application of local anesthesia in major surgery

Abstract

1. 1. Novocaine in weak dilution is still the most efficacious and most reliable drug for use in local anesthesia. 2. 2. I would recommend local anesthesia in all inguinal herniotomies and bad risk thyroidectomies, aside from minor procedures, because in these two procedures local anesthesia has distinct advantages. It is true that with intelligent and skillful use of local anesthesia by one expert in its technique, a great many more major operations can be successfully performed. Furthermore, it must not be forgotten that local anesthesia in a major operation can be used up to the painful part and then nitrous oxide or a small quantity of ether may be given to tide the patient over the painful procedure, a method which is now known as combined anesthesia or anocithesia. 3. 3. Local infiltration is never permissible in infected or cancerous tissues because of the danger of disseminating the infection or cancerous lesion. 4. 4. As with other methods of anesthesia, local anesthesia has its indications and contraindications, its possibilities and its limitations. As has been said, it is especially valuable in thyroidectomies and herniotomies. For other major operations it does not always remove all painful and other disagreeable sensations and it makes demands on the surgeon's time, patience and technique, that all operators are not willing to allow; and only certain patients have the desire or fortitude to remain aware while their operation is in progress. At one time Matas observed, “It is this tax upon the operator's attention and the vigilance required to keep the inhibitory powers of the patient under control, and the time consumed in the anesthetizing procedure that will prevent cocaine and the local analgesics from gaining ascendency in the crowded amphitheatres of popular teachers where quick and brilliant work is expected by an impatient audience.”