SPMLs & EtOH

Who made this wrong – blameless – cause into discarded history? Mostly the Navy. The medical corps in the military are shared and the largest, most extensive, is the navy. The corpsmen – in war – were faced with narcotic dose risk to badly wounded. Safer, was local anesthesia & fast transport. By putting a needle right onto the femoral nerve (easy to find & confirm by rotating the needle to trigger the nerve) local anesthetic diluted in about 100 cc of saline was run. With that, numbness traveled upstream until BOTH legs and up to mid abdomen were pain free. Nerve surfaces do not bind to the surrounding fat and so that nerve/fat interface is a rather quick CONDUIT. Given enough VOLUME (the 100 cc) fluid can easily flow up and into the spinal canal traveling along pelvic plexus nerves. It is even reliable. When ethanol was used at surgery, this could not happen. It was hard enough to keep the drips on that small area. There are variations in internal anatomy as there are in faces. When done by blind injection, the practice was often to try a few spots and just use a lot – 30 cc here, 30cc there. Some of it has got to hit the nerve. And it did. But, if by LUCK (bad luck) – IF – that needle was dead on accurate, right where the doctor was wanting it, and 30cc went in, then distant leg burning, and occasional intraspinal effects followed (but not from local anesthetic which is safe even when injected directly into the intraspinal space (spinal anesthesia). Phenol or any alcohol can go intraspinal if used in volume. This war time field anesthesia was the main way all military lower limb surgery was done with great effect and low complication. Dentists who were also doubled as anesthesiologists (being by far the biggest medical section) were quite expert in this. Now, in a civilian setting, our own military background kept us from using the large volumes that we knew were being injected by others for nerve blocks. Our rule was 1cc or nothing. To make this a reliable method, we brought in an electrical engineer wizard Dr. Michael Polchaninoff, who also has a podiatry degree. He helped us use a spinal needle passed through a