 | This article's lead section may not adequately summarize its contents.(September 2016) |
The history of neuraxial anesthesia goes back to 1885.
| This article's lead section may not adequately summarize its contents.(September 2016) |
The history of neuraxial anesthesia goes back to 1885.
In 1855, Friedrich Gaedcke (1828–1890) became the first to chemically isolate cocaine, the most potent alkaloid of the coca plant. Gaedcke named the compound "erythroxyline". [1] [2]
In 1884, Austrian ophthalmologist Karl 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. [3] His findings were presented a few weeks later at annual conference of the Heidelberg Ophthalmological Society. [4] The following year, William Halsted (1852–1922) performed the first brachial plexus block. [5] Also in 1885, James Leonard Corning (1855–1923) injected cocaine between the spinous processes of the lower lumbar vertebrae, first in a dog and then in a healthy man. [6] [7] His experiments are the first published descriptions of the principle of neuraxial blockade. [8]
On August 16, 1898, German surgeon August Bier (1861–1949) performed surgery under spinal anesthesia in Kiel. [9] Following the publication of Bier's experiments in 1899, a controversy developed about whether Bier or Corning performed the first successful spinal anesthetic. [10] [11]
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 a spinal or an epidural block. The dose of cocaine used by Corning was eight times higher than that used by Bier and Tuffier. Despite this much higher dose, the onset of analgesia in Corning's human subject was slower and the dermatomal level of ablation of sensation was lower. Also, Corning did not describe seeing the flow of cerebrospinal 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 the epidural space, and not the subarachnoid space. [11] Finally, Corning was incorrect in his theory on the mechanism of action of cocaine on the spinal nerves and spinal cord. He proposed – mistakenly – that the cocaine was absorbed into the venous circulation and subsequently transported to the spinal cord. [11]
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. [11]
Romanian surgeon Nicolae Racoviceanu-Pitești (1860–1942) was the first to use opioids for intrathecal analgesia; he presented his experience in Paris in 1901. [12] [13]
In 1921, Spanish military surgeon Fidel Pagés (1886–1923) developed the modern technique of lumbar epidural anesthesia, [14] which was popularized in the 1930s by Italian surgery professor Achille Mario Dogliotti (1897–1966). [13] 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 as Dogliotti's principle. [15] Eugen Bogdan Aburel (1899–1975) was a Romanian surgeon and obstetrician who in 1931 was the first to describe blocking the lumbar plexus during early labor, followed by a caudal epidural injection for the expulsion phase. [16] [17]
Beginning in October 1941, Robert Andrew Hingson (1913–1996), Waldo B. Edwards and James L. Southworth, working at the United States Marine Hospital at Stapleton, on Staten Island in New York, developed the technique of continuous caudal anesthesia. [18] [19] [20] [21] Hingson and Southworth first used this technique in an operation to remove the varicose 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 chief obstetrician 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. [20]
The first use of continuous caudal anesthesia in a laboring woman was on January 6, 1942, when the wife of a United 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 of rheumatic 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. [22]
The first described placement of a lumbar epidural catheter was performed by Manuel Martínez Curbelo (5 June 1906–1 May 1962) on January 13, 1947. [23] [24] Curbelo, a Cuban anesthesiologist, introduced a 16 gauge Tuohy needle into the left flank of a 40-year-old woman with a large ovarian cyst. Through this needle, he introduced a 3.5 French ureteral catheter made of elastic silk 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 the International Anesthesia Research Society and the International College of Anesthetists, in New York City. [17] [25]
Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.
A local anesthetic (LA) is a medication that causes absence of all sensation in a specific body part without loss of consciousness, as opposed to a general anesthetic, which eliminates all sensation in the entire body and causes unconsciousness. Local anesthetics are most commonly used to eliminate pain during or after surgery. When it is used on specific nerve pathways, paralysis also can be induced.
Spinal anaesthesia, also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathetic) blockade. Administering analgesics in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation, some autonomic blockade, but no sensory or motor block. Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.
A Tuohy (/tOO-ee/) needle is a hollow hypodermic needle, very slightly curved at the end, suitable for inserting epidural catheters.
Epidural administration is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics, diagnostic medicines such as radiocontrast agents, and other medicines such as glucocorticoids. Epidural administration involves the placement of a catheter into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by Spanish military surgeon Fidel Pagés.
Remifentanil, marketed under the brand name Ultiva is a potent, short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is used for sedation as well as combined with other medications for use in general anesthesia. The use of remifentanil has made possible the use of high-dose opioid and low-dose hypnotic anesthesia, due to synergism between remifentanil and various hypnotic drugs and volatile anesthetics.
August Karl Gustav Bier was a German surgeon. He was the first to perform spinal anesthesia and intravenous regional anesthesia.
Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease feeling in a specific area. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It is available mixed with a small amount of epinephrine to increase the duration of its action. It typically begins working within 15 minutes and lasts for 2 to 8 hours.
Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve. Neurolytic block, the deliberate temporary degeneration of nerve fibers through the application of chemicals, heat, or freezing, produces a block that may persist for weeks, months, or indefinitely. Neurectomy, the cutting through or removal of a nerve or a section of a nerve, usually produces a permanent block. Because neurectomy of a sensory nerve is often followed, months later, by the emergence of new, more intense pain, sensory nerve neurectomy is rarely performed.
Chloroprocaine is a local anesthetic given by injection during surgical procedures and labor and delivery. Chloroprocaine vasodilates; this is in contrast to cocaine which vasoconstricts. Chloroprocaine is an ester anesthetic.
Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.
Dogliotti's principle is a principle in epidural anaesthesia first described by Professor Achille Mario Dogliotti in 1933. It is a method for the identification of the epidural space, a potential space. As a needle is advanced through the ligamentum flavum, to the epidural space, with constant pressure applied to the piston of a syringe, loss of resistance occurs once the needle enters the epidural space due to the change in pressure. The identification of this space, allows subsequent administration of epidural anaesthesia, a technique used primarily for analgesia during childbirth.
Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater. The headache is severe and described as "searing and spreading like hot metal", involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement and sitting or standing and is relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are also common.
Eugen Bogdan Aburel was a Romanian surgeon and obstetrician. He introduced innovative techniques in gynecologic surgery.
Continuous wound infiltration (CWI) refers to the continuous infiltration of a local anesthetic into a surgical wound to aid in pain management during post-operative recovery.
Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. The subject can remain awake during the ensuing surgical procedure, or they can be sedated or even fully anesthetized if necessary.
The following outline is provided as an overview of and topical guide to anesthesia:
James Leonard Corning was an American neurologist, mainly known for his early experiments on neuraxial blockade in New York City.
Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').
Caudal anaesthesia is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults it is used for chronic low back pain management.
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