. 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. of retaining it in situby constriction. Aside from the danger in the solution injected, if made in effectivequantity and strength, the anatomy of this region should be sufficientto deter any but the most venturesome from this practice. Above the clavicle the brachial plexus lies well to the base of theneck on the scalenus medius, just to the outer border o
. 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. of retaining it in situby constriction. Aside from the danger in the solution injected, if made in effectivequantity and strength, the anatomy of this region should be sufficientto deter any but the most venturesome from this practice. 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 thescalenus with the plexus above, giving off in this neighborhoodbranches of large size (Fig. 29). Many veins are encountered inall directions, and, while their puncture with a fine needle would notbe of much consequence, an intravenous injection may prove a moreserious matter. 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. THE UPPER AND LOWER EXTREMITIES 219 external maxillary ihoracoJonal nerve?cpiga- long thoracic nerve Fig. 2q.—The nerves and arteries of the deep layers of the neck and of the axilla.(Sixth layer of neck, deeper layers of the axilla.) The greater portions of the infra-hyoid muscles and of the common carotid artery have been removed; the clavicle hasbeen disarticulated at the sternoclavicular joint and sawn through at about its pectoralis major and minor have been divided and the deltoid incised along thedeltoid branch of the thoraco-acromial artery. *, Accessory sympathetic ganglion.(Sobotta and McMurrich.) Notwithstanding these anatomic arrangements, paraneural injec-tions have been made in both positions. The Kulenkampff method,above the clavicle, has been favorably spoken of by Braun,
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