No Anesthetics!
Andrushko and Verano argue that the Incas performed trepanation primarily to treat head injuries incurred during battle, because the holes are most often found at the front of the skull to the left, consistent with injuries caused by a right-handed opponent during face-to-face combat, and because adult males are overrepresented in the sample. The procedure was evidently used to treat mastoiditis (an infection of the region of the temporal bone behind the ear) as well.

