Intravenous Regional Anesthesia: A Historical Overview and Clinical Review.

Intravenous regional anesthesia (IVRA) is an established, safe and simple technique, being applicable for various surgeries on the upper and lower limbs. In 1908, IVRA was first described by the Berlin surgeon August Bier, hence the name "Bier's Block". Although his technique was effective, it was cumbersome and fell into disuse when neuroaxial and percutaneous plexus blockades gained widespread popularity in the early 20th century. In the 1960s, it became widespread, when the New Zealand anesthesiologist Charles McKinnon Holmes praised its use by means of new available local anesthetics. Today, IVRA is still popular in many countries being used in the emergency room, for outpatients and for high-risk patients with contraindications for general anesthesia. IVRA offers a favorable risk-benefit ratio, cost-effectiveness, sufficient muscle relaxation and a fast on- and offset. New upcoming methods for monitoring, specialized personnel and improved emergency equipment made IVRA even safer. Moreover, IVRA may be applied to treat complex regional pain syndromes. Prilocaine and lidocaine are considered as first-choice local anesthetics for IVRA. Also, various adjuvant drugs have been tested to augment the effect of IVRA, and to reduce post-deflation tourniquet pain. Since major adverse events are rare in IVRA, it is regarded as a very safe technique. Nevertheless, systemic neuro- and cardiotoxic side effects may be linked to an uncontrolled systemic flush-in of local anesthetics and must be avoided. This review gives a historical overview of more than 100 years of experience with IVRA and provides a current view of IVRA with relevant key facts for the daily clinical routine.

Cocaine and Achieving Rapid Pulpal Anesthesia Prior to Extirpation.

Prior to the effective use of local anesthetics to achieve profound pulpal anesthesia before extirpation, whether in the form of a nerve block or infiltration, or in some cases the use of intrapulpal injections,1, 2 the clinician was faced with a challenge to ensure that the patient would be pain free during the procedure. In these cases the use of nitrous oxide and oxygen was common. Not so common was the use of cocaine or a solution of cocaine hydrochloride that was advocated to penetrate the dentinal tubules and create pulpal insensibility in the late 1800s.3, 4.

Local Anesthetic Systemic Toxicity.

Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients. This article provides the perioperative nurse with information about local anesthetics, the signs and symptoms of local anesthetic systemic toxicity, and the information needed to manage a patient experiencing this complication.

Procaine and Local Anesthetic Toxicity: A Collaboration Between the Clinical and Basic Sciences.

In 1924, the Therapeutic Research Committee of the American Medical Association appointed a special committee to investigate deaths following the administration of local anesthetics. The Committee for the Study of Toxic Effects of Local Anesthetics found procaine, although a safer clinical alternative to cocaine, was capable of causing death when large doses were injected into tissues and advised that it should be used with caution. This article describes a collaboration beginning in 1928 between Dr John Lundy of the Mayo Clinic and Dr Robert Isenberger of the University of Kansas, which arose from a controversy surrounding systemic adverse reactions to procaine. Isenberger then traveled to the Mayo Clinic to conduct research on various procaine local and spinal anesthesia doses and sodium amytal's protective effect against procaine-induced toxicity. Lundy and Isenberger's work would add to the ongoing discovery of systemic reactions to local anesthetics.

[Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde]. / Anfänge der kontinuierlichen Wundinfusion mit Lokalanästhetika : Unter besonderer Berücksichtigung der Beiträge von Walter Capelle und Ewald Fulde.

Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. In the early 1930s there were first sustained efforts to improve the efficiency and quality of pain therapy, especially after upper abdominal surgery by continuous wound infiltration with local anesthetics via intraoperatively introduced special cannulas. This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.

Changes in Publication-Based Academic Interest in Local Anesthetics Over the Past 50 Years.

PURPOSE: To present the history of changes in academic interest in local anesthetics quantitatively. METHODS: The changes in publication-based academic interest in local anesthetics were assessed using information from the database of PubMed. The assessment was mostly based on the following indices: general popularity index (GPI), representing the proportion of articles on a drug relative to all articles in the field of regional anesthesia, and specific popularity index (SPI), representing the proportion of articles on a drug relative to all articles in one of the four forms of regional anesthesia: local anesthesia, spinal anesthesia, epidural anesthesia, and peripheral nerve blocks. RESULTS: The most important general feature of the changes in publication-based academic interest in local anesthetics for the past 50 years was the concentration of this interest on a very limited number of drugs. By 2010-2014, only three anesthetics demonstrated the GPI value above 4.0: bupivacaine (10.1), lidocaine (10.0), and ropivacaine (4.6). All other local anesthetics had GPI declining mostly to less than 1.0 (2010-2014). The rate of change in publication-based academic interest was very slow in both its increase and decline. The most profound change in publication-based academic interests was caused by the introduction of bupivacaine. During a 20-year period (from 1965-1969 to 1985-1989), bupivacaine's GPI increased from 1.3 to 12.9. CONCLUSION: A slowly developing concentration of publication-based academic interest on a very limited number of local anesthetics was the dominant feature related to this class of anesthetic agents.

[History and Technique of Epidural Anaesthesia]. / Epiduralanästhesie - Geschichte und Technik der Epiduralanästhesie.

In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique.

[From the legacy of Carl Koller. Notations on his experiments with cocaine]. / Aus dem Nachlass von Carl Koller: Aufzeichnungen zu seinen Experimenten mit Kokain.

The history of local anesthesia began with the discovery of the anesthetic properties of cocaine by the physician Carl Koller from Vienna 130 years ago. After he had realized the options for painless surgery using this substance, he analyzed cocaine in detail from this point of view and evaluated the drug's significance in animal experiments, in self-experiments and in colleagues. The findings of his experiments were accurately recorded by Koller and after his death remained in the possession of the family for a long time until his daughter Hortense Becker-Koller handed these documents over to the Library of Congress in Washington. These recordings were recently studied and will now be presented to the public for the first time ever.

Local anaesthesia through the action of cocaine, the oral mucosa and the Vienna group.

Local anaesthesia through the action of cocaine was introduced in Europe by the Vienna group, which includeed Freud, Koller and Königstein. Before using the alkaloid in animal or human experimentation all these scientists tested it on their oral mucosa - so-called self-experimentation. Some of them with different pathologies (that is, in the case of Freud), eventually became addicted to the alkaloid. Here we attempt to describe the people forming the so-called 'Vienna group', their social milieu, their experiences and internal disputes within the setting of a revolutionary discovery of the times.

From the Journal archives: Epidural anesthesia in young children: what have we learned in the past 60 years?

UNLABELLED: Francis G. Ruston MD CITATION: Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954: 1: 37-44. PURPOSE: The author describes the use of single-shot epidural anesthesia in a series of 44 infants and children. The patients were anesthetized in hospitals in Hamilton, Ontario from 1949 until the time of publication in 1954. The study aimed to describe the indications and efficacy of this technique as well as any apparent complications. A detailed description of the management of these patients was given, including many tips and suggestions that are still applicable in 2013. PRINCIPAL FINDINGS: Seventy-seven infants and children received epidural anesthesia for a variety of procedures, particularly for pyloric stenosis. Forty-four of the procedures were carried out by the author. All patients survived, apart from one child who died of recurrent intestinal obstruction unrelated to the anesthetic. It was found, after some experience, that the sitting position was preferable for epidural needle insertion. Use of the hanging drop technique for identification of the epidural space proved to be simple and reliable. Surgical conditions were found to be excellent and relaxation was profound; however, some sedation was often required to obtain optimal conditions for surgery. The surgeons became sold on the technique and began to request an epidural on a regular basis. CONCLUSIONS: Epidural anesthesia in infants and young children is effective for a variety of procedures below the diaphragm, even in moribund patients.

[Cataract--short history of treatment methods tried and abandoned]. / Cataracta--scurt istoric metode încercate si abandonate.

The author presents a brief history of treatment methods used for cataract, emphasizing key moments and highlightening Romanian contribution to this kind of surgery.