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Chapter: Clinical Anesthesiology: The Practice of Anesthesiology

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Local & Regional Anesthesia

The medicinal qualities of coca had been used by the Incas for centuries before its actions were first observed by Europeans.

LOCAL & REGIONAL ANESTHESIA

The medicinal qualities of coca had been used by the Incas for centuries before its actions were first observed by Europeans. Cocaine was isolated from coca leaves in 1855 by Gaedicke and was purified in1860 by Albert Niemann. The original applica-tion of modern local anesthesia is credited toCarl Koller, at the time a house officer in ophthal-mology, who demonstrated topical anesthesia of the eye with cocaine in 1884. Later in 1884 William Hal-sted used cocaine for intradermal infiltration and nerve blocks (including blocks of the facial nerve, brachial plexus, pudendal nerve, and posterior tibial nerve). August Bier is credited with administering the first spinal anesthetic in 1898. He was also the first to describe intravenous regional anesthesia (Bier block) in 1908. Procaine was synthesized in 1904 by Alfred Einhorn and within a year was used clinically as a local anesthetic by Heinrich Braun. Braun was also the first to add epinephrine to pro-long the duration of local anesthetics. Ferdinand Cathelin and Jean Sicard introduced caudal epidural anesthesia in 1901. Lumbar epidural anesthesia was described first in 1921 by Fidel Pages and again (independently) in 1931 by Achille Dogliotti. Addi-tional local anesthetics subsequently introduced include dibucaine (1930), tetracaine (1932), lido-caine (1947), chloroprocaine (1955), mepivacaine (1957), prilocaine (1960), bupivacaine (1963), and etidocaine (1972). The most recent additions, ropi-vacaine and levobupivacaine, have durations of action similar to bupivacaine but less cardiac toxic-ity .

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