. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the writersexperience, and that of their associates, no cases have been observed. The pathogenesis of these palsies is not at all clear. They haveoccurred most frequently following the use of stovain, but also hap-pen with the other agents. The irritating qualities of stovain andits action on motor nerves is well recognized, but many of the otheragents are
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. the writersexperience, and that of their associates, no cases have been observed. The pathogenesis of these palsies is not at all clear. They haveoccurred most frequently following the use of stovain, but also hap-pen with the other agents. The irritating qualities of stovain andits action on motor nerves is well recognized, but many of the otheragents are supposed to be free from such action. One theory isthat it is due to changes in the pressure of the cerebrospinal fluid,permitting pressure or traction on the nerves as they course alongthe undersurface of the brain. This, however, is very unlikely, as itwould occur just as frequently with low puncture, and also with opera-tions upon the spinal cord, when frequently large quantities of cere-brospinal fluid escape. The fact that occasionally palsies have fol-lowed cerebral operations has no analogous bearing here, for in suchcases the disturbance was most likely due to edema or congestionfollowing the procedure. 448 LOCAL ANESTHESIA. •g-g-a-a-g3 o 3s jjj ja ja js J ^ <° -S SPINAL ANALGESIA AND EPIDURAL INJECTIONS 449 The possibility of hemorrhage being the cause has been advanced,but has not met with much support. It was suggested that thechange in the cerebrospinal pressure acting upon diseased vesselsinduced minute ruptures, but, if such were the case, we would mostlikely have associated disturbances elsewhere with greater frequencythan they occur. The fact that these disturbances occur most often in high punctureswould suggest the direct action of the agents or toxic properties in-duced by this preparation acting directly upon the nerves, or theirorigin in the floor of the fourth ventricle; to act on the nerve-trunksthemselves would necessitate a much higher ascent of
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