. 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. al root of external jugular vein. (Sobotta andMcMurrich.) the posterior margin of the insertion of the sternocleidomastoid. Theoccipitalis major emerges upon the surface of the occiput through a THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 479 cleft in the trapezius muscle, along with the occipital artery, the thirdoccipital, sometimes an independent nerve, p
. 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. al root of external jugular vein. (Sobotta andMcMurrich.) the posterior margin of the insertion of the sternocleidomastoid. Theoccipitalis major emerges upon the surface of the occiput through a THE HEAD, SCALP, CRANIUM, BRAIN, AND FACE 479 cleft in the trapezius muscle, along with the occipital artery, the thirdoccipital, sometimes an independent nerve, passing slightly nearerthe midline; to reach both of these nerves a deep line of infiltration canbe carried from the posterior occipital protuberance one-third of thedistance toward the auricle. As emphasized by Hartel, and referredto by Bier and Krause, in intracranial operations regional methods ofanesthesia should be preferred to infiltration around the operativearea in such operations where the electric excitability of the cerebralcortex should not be disturbed, as in operations for epilepsy. Whenperforming such operations under infiltration anesthesia the diffusionof the anesthesia may reach the cerebral cortex and interfere with. Fig. 150.—Line of subcutaneous infiltration blocking occipital and auricularis magnusnerves and resulting area of anesthesia. electric tests. It must be remembered that here as elsewhere bone isinsensitive to pain after the periosteum has been anesthetized ordenuded, and it can be freely operated upon with trephine, chisel,rongeur, or saw without the least discomfort, beyond the fact thatthe patient hears and feels the jar of the manipulations. The dura isinsensitive to wounds inflicted through incisions or the application offorceps, but is sensitive to traction should it be pulled upon, conse-quently it can be freely incised and turned back without pain. Thisstatement holds good for the vertex and lateral surfaces of the brain,the areas most fr
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