Anesthesia of The Brachial Plexus - History


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". 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. His findings were presented a few weeks later at annual conference of the Heidelberg Ophthalmological Society. The following year, William Halsted (1852–1922) performed the first brachial plexus block. Using a surgical approach in the neck, Halsted applied cocaine to the brachial plexus. In January 1900, Harvey Cushing (1869–1939) — who was at that time one of Halsted's surgical residents — applied cocaine to the brachial plexus prior to dividing it, during a forequarter amputation for sarcoma.

The first percutaneous supraclavicular block was performed in 1911 by German surgeon Diedrich Kulenkampff (1880–1967). Just as his older colleague August Bier (1861–1949) had done with spinal anesthesia in 1898, Kulenkampff subjected himself to the supraclavicular block. Later that year, Georg Hirschel (1875–1963) described a percutaneous approach to the brachial plexus from the axilla. In 1928, Kulenkampff and Persky published their experiences with a thousand blocks without apparent major complications. They described their technique with the patient in the sitting position or in the supine position with a pillow between the shoulders. The needle was inserted above the midpoint of the clavicle where the pulse of the subclavian artery could be felt and it was directed medially toward the second or third thoracic spinous process.

By 1948, extensive experience had been gained worldwide with brachial plexus block. The subclavian perivascular block was first described by Winnie and Collins in 1964. This approach became popular as it was associated with less incidence of pneumothorax than the Kulenkampff approach. The infraclavicular approach was first developed by Raj.

In 1946, F. Paul Ansbro was the first to describe a continuous brachial plexus block technique. He secured a needle in the supraclavicular fossa and attached tubing connected to a syringe through which he could inject incremental doses of local anesthetic. In 1977, Selander described a technique for continuous brachial plexus block using an intravenous catheter secured in the axilla.

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