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Thehistory of neuraxial anaesthesia dates back to the late 1800s[1] and is closely intertwined with the development of anaesthesia in general.[2]Neuraxial anaesthesia, in particular, is a form of regional analgesia placed in or around theCentral Nervous System, used for pain management and anaesthesia for certain surgeries and procedures.[3]
In 1855,Friedrich Gaedcke (1828–1890) became the first to chemically isolatecocaine, the most potentalkaloid of thecoca plant. Gaedcke named the compound "erythroxyline".[4][5]
In 1884, AustrianophthalmologistKarl Koller (1857–1944) instilled a 2% solution of cocaine into his own eye and tested its effectiveness as a local anesthetic by pricking the eye with needles.[6] His findings were presented a few weeks later at annual conference of the Heidelberg Ophthalmological Society.[7] The following year,William Halsted (1852–1922) performed the first brachial plexus block.[8] Also in 1885,James Leonard Corning (1855–1923)injected cocaine between thespinous processes of the lowerlumbar vertebrae, first in a dog and then in a healthy man.[9][10] His experiments are the first published descriptions of the principle ofneuraxial blockade.[11]
On August 16, 1898, German surgeonAugust Bier (1861–1949) performed surgery underspinal anesthesia inKiel.[12] Following the publication of Bier's experiments in 1899, a controversy developed about whether Bier or Corning performed the first successful spinal anesthetic.[13][14]
There is no doubt that Corning's experiments preceded those of Bier. For many years however, a controversy centered around whether Corning's injection was aspinal or anepidural block. The dose of cocaine used by Corning was eight times higher than that used by Bier andTuffier. Despite this much higher dose, the onset ofanalgesia in Corning's human subject was slower and thedermatomal level of ablation of sensation was lower. Also, Corning did not describe seeing the flow ofcerebrospinal fluid in his reports, whereas both Bier and Tuffier did make these observations. Based on Corning's own description of his experiments, it is apparent that his injections were made into theepidural space, and not thesubarachnoid space.[14] Finally, Corning was incorrect in his theory on themechanism of action of cocaine on thespinal nerves andspinal cord. He proposed – mistakenly – that the cocaine was absorbed into thevenous circulation and subsequently transported to the spinal cord.[14]
Although Bier properly deserves credit for the introduction of spinal anesthesia into the clinical practice of medicine, it was Corning who created the experimental conditions that ultimately led to the development of both spinal and epidural anesthesia.[14]
In 1921, Spanish military surgeonFidel Pagés (1886–1923) developed the modern technique of lumbar epidural anesthesia,[17] which was popularized in the 1930s by Italian surgery professorAchille Mario Dogliotti [it] (1897–1966).[16] Dogliotti is known for describing a "loss-of-resistance" technique, involving constant application of pressure to the plunger of a syringe to identify the epidural space whilst advancing the Tuohy needle – a technique sometimes referred to asDogliotti's principle.[18]Eugen Bogdan Aburel (1899–1975) was a Romanian surgeon and obstetrician who in 1931 was the first to describe blocking thelumbar plexus during early labor, followed by a caudal epidural injection for theexpulsion phase.[19][20]
Beginning in October 1941,Robert Andrew Hingson (1913–1996), Waldo B. Edwards and James L. Southworth, working at theUnited States Marine Hospital at Stapleton, on Staten Island in New York, developed the technique of continuous caudal anesthesia.[21][22][23][24] Hingson and Southworth first used this technique in an operation to remove thevaricose veins of a Scottish merchant seaman. Rather than removing the caudal needle after the injection as was customary, the two surgeons experimented with a continuous caudal infusion of local anesthetic. Hingson then collaborated with Edwards, the chiefobstetrician at the Marine Hospital, to study the use of continuous caudal anesthesia for analgesia during childbirth. Hingson and Edwards studied the caudal region to determine where a needle could be placed to deliver anesthetic agents safely to the spinal nerves without injecting them into the cerebrospinal fluid.[23]
The first use of continuous caudal anesthesia in a laboring woman was on January 6, 1942, when the wife of aUnited States Coast Guard sailor was brought into the Marine Hospital for an emergency Caesarean section. Because the woman had rheumatic heart disease (heart failure following an episode ofrheumatic fever during childhood), her doctors believed that she would not survive the stress of labor but they also felt that she would not tolerate general anesthesia due to her heart failure. With the use of continuous caudal anesthesia, the woman and her baby survived.[25]
The first described placement of a lumbar epidural catheter was performed byManuel Martínez Curbelo (5 June 1906–1 May 1962) on January 13, 1947.[26][27] Curbelo, a Cuban anesthesiologist, introduced a 16 gauge Tuohy needle into the left flank of a 40-year-old woman with a largeovarian cyst. Through this needle, he introduced a 3.5Frenchureteral catheter made of elasticsilk into the lumbar epidural space. He then removed the needle, leaving the catheter in place and repeatedly injected 0.5% percaine (cinchocaine, also known as dibucaine) to achieve anesthesia. Curbelo presented his work on September 9, 1947, at the 22nd Joint Congress of theInternational Anesthesia Research Society and the International College of Anesthetists, in New York City.[20][28]
^Olawin, Abdulquadri M.; M Das, Joe (2023),"Spinal Anesthesia",StatPearls, Treasure Island (FL): StatPearls Publishing,PMID30725984, retrieved2023-08-17
^Zaunick, R (1956). "Early history of cocaine isolation: Domitzer pharmacist Friedrich Gaedcke (1828–1890); contribution to Mecklenburg pharmaceutical history".Beitr Gesch Pharm Ihrer Nachbargeb.7 (2):5–15.PMID13395966.
^Koller, K (1884). "Über die verwendung des kokains zur anästhesierung am auge" [On the use of cocaine for anesthesia on the eye].Wiener Medizinische Wochenschrift (in German).34:1276–1309.
^Karch, SB (2006)."Genies and furies".A brief history of cocaine from Inca monarchs to Cali cartels : 500 years of cocaine dealing (2nd ed.). Boca Raton, Florida: Taylor & Francis Group. pp. 51–68.ISBN978-0849397752.
^Halsted, WS (1885-09-12). "Practical comments on the use and abuse of cocaine; suggested by its invariably successful employment in more than a thousand minor surgical operations".New York Medical Journal.42:294–5.
^Corning, JL (1885). "Spinal anaesthesia and local medication of the cord".New York Medical Journal.42:483–5.
^Corning, JL (1888). "A further contribution on local medication of the spinal cord, with cases".New York Medical Record:291–3.
^abJ. C. Diz, A. Franco, D. R. Bacon, J. Rupreht, and J. Alvarez (eds.);The history of anesthesia: proceedings of the Fifth International Symposium, Elsevier (2002), pp. 205–6, 0-444-51003-6
^Pagés, F (1921). "Anestesia metamérica".Revista de Sanidad Militar (in Spanish).11:351–4.
^Edwards, WB; Hingson, RA (1942). "Continuous caudal anesthesia in obstetrics".American Journal of Surgery.57 (3):459–64.doi:10.1016/S0002-9610(42)90599-3.
^Hingson, RA; Edwards, WB (1942). "Continuous Caudal Anesthesia During Labor and Delivery".Anesthesia and Analgesia.21:301–11.doi:10.1213/00000539-194201000-00072.
^Hingson, RA; Edwards, WB (1943). "Continuous Caudal Analgesia in Obstetrics".Journal of the American Medical Association.121 (4):225–9.doi:10.1001/jama.1943.02840040001001.
Hirschel, G (1911-07-18). "Die anästhesierung des plexus brachialis fuer die operationen an der oberen extremitat" [Anesthesia of the brachial plexus for operations on the upper extremity].Munchener Medizinische Wochenschrift (in German).58:1555–6.
Kulenkampff, D (1911). "Zur anästhesierung des plexus brachialis" [On anesthesia of the brachial plexus].Zentralblatt für Chirurgie (in German).38:1337–40.
