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The history of neuraxial anesthesia goes back to 1885. ==19th century== In 1855, Friedrich Gaedcke (18281890) became the first to chemically isolate cocaine, the most potent alkaloid of the coca plant. Gaedcke named the compound "erythroxyline". In 1884, Austrian ophthalmologist Karl Koller (18571944) instilled a 2% solution of cocaine into his own eye and tested its effectiveness as a local anesthetic by pricking the eye with needles. His findings were presented a few weeks later at annual conference of the Heidelberg Ophthalmological Society. The following year, William Halsted (18521922) performed the first brachial plexus block. Also in 1885, James Leonard Corning (18551923) injected cocaine between the spinous processes of the lower lumbar vertebrae, first in a dog and then in a healthy man. His experiments are the first published descriptions of the principle of neuraxial blockade. On August 16, 1898, German surgeon August Bier (18611949) performed surgery under spinal anesthesia in Kiel. Following the publication of Bier's experiments in 1899, a controversy developed about whether Bier or Corning performed the first successful spinal anesthetic. 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.〔 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.〔 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.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「History of neuraxial anesthesia」の詳細全文を読む スポンサード リンク
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