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 . the deltoid incised along thedeltoid branch of the thoraco-acromial artery.* Accessory sympathetic ganglion.(Sobotta and McMurrich.) Above the clavicle the brachial plexus lies well to the base of theneck on the scalenus medius, just to the outer border of the scalenusanticus; the subclavian artery in this position passes behind the THE UPPER AND LOWER EXTREMIT
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 . the deltoid incised along thedeltoid branch of the thoraco-acromial artery.* Accessory sympathetic ganglion.(Sobotta and McMurrich.) Above the clavicle the brachial plexus lies well to the base of theneck on the scalenus medius, just to the outer border of the scalenusanticus; the subclavian artery in this position passes behind the THE UPPER AND LOWER EXTREMITIES 235 scalenus with the plexus above, giving off in this neighborhoodbranches of large size (Fig. 29). Many veins are encountered in alldirections, and, while their puncture with a fine needle would not be ofmuch consequence, an intravenous injection may prove a more seriousmatter. Below the clavicle the plexus lies to the outer side of the first por-tion of the artery, embraces the second portion, and lies somewhatmore widely distributed around the third. The vein in both cases isfairly out of the way. Notwithstanding these anatomic arrangements, paraneural injec-tions have been made in both positions. The Kulenkampff Fig. 30.—Thorax from above, after Kulenkampff. On one side is shown the posi-tion of the brachial plexus and subclavian artery to the clavicle, on the other the direc-tion the needle should take in making the injection: a, Subclavian vein; b, point ofattachment of anterior scalenus muscle; c, subclavian artery; d, brachial plexus; e,point of attachment of scalenus medius muscle. (From Braun.) above the clavicle, has been favorably spoken of by Braun, andpracticed by himself and many others, and is done in the followingmanner: That portion of the plexus is selected for injection at thepoint where it passes over the first rib; in this position the arterylies below and on the inner side, the clavicle above and in front, thepleura and lung beneath (Fig.
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