. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. supported forward on a pillow,the lumbar curve is diminished, while that of the dorsum is pelvis would have to be raised very high indeed to bring the 448 LOCAL ANESTHESIA level of the dorsal curve at the fifth or sixth spine above that of theforamen magnum, with the head and neck bent forward, as is, therefore, but little hkeliho
. Local and regional anesthesia; with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. supported forward on a pillow,the lumbar curve is diminished, while that of the dorsum is pelvis would have to be raised very high indeed to bring the 448 LOCAL ANESTHESIA level of the dorsal curve at the fifth or sixth spine above that of theforamen magnum, with the head and neck bent forward, as is, therefore, but little hkelihood of the heavy compound reach-ing the medulla, or even into the cervical region at all. In some casesin Germany, inversion has been carried to a very extreme degree, thehead being unsupported, with the idea of displacing the whole massof the cerebrospinal fluid toward the cranial cavity. But we mustremember that in these cases the compounds have usually been oflow specific gravity, and in the case of Biers (see above) actuallylighter than the spinal fluid, so that it would not be likely to move asfar as the neck by any oscillation of the column of the spinal have been a few cases, however, both in France and Germany,. Fig. 125.—Photograph of the same patient gently rolled over on the back with thesame relations of head, neck, and pelvis. The line across the fourth lumbar spine is seen,and also that the dorsal curve is deeper than the previous lateral curve. From a photo-graph by Dr. E. Worrall. (Barker, in Brit. Med. Jour.) in which the analgesia has extended over the whole head, as well asthe rest of the body, without injury, but the details as to injectionand pelvic elevation are not given. They were probably instancesof diffusion helped by oscillation. Personally, I have never aimed atgetting a higher analgesia than to the transverse nipple line. At thecaudal curve the effects of a heavy compound can be limited in thesame way by position. If the patient be sea
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