Human Ultrasound Guided Regional Anaesthesia

Regional anaesthesia was first performed in 1884 by Karl Koller, an Austrian ophthalmologist in Vienna, using cocaine for eye surgery. This was followed in 1898 by August Bier, a German surgeon, using cocaine for spinal anaesthesia.

The advantages of regional anaesthesia have been debatedad infinitum: reduced cardiorespiratory complications, less thromboembolic events, modification of the stress response, improved patient satisfaction to name but a few. However, the overwhelming benefit is one of superior perioperative analgesia. This applies to both central and peripheral nerve blockade.

The popularity of regional anaesthesia fluctuated throughout the 20th Century mainly due to adverse incidents. The most famous of these was the Woolley and Roe case. In 1947, in Chesterfield, 2 men became paraplegic following spinal anaesthesia given by the same anaesthetist, using the same drug, on the same day, in the same hospital. It was originally thought that phenol had contaminated the local anaesthetic ampoules, but later evidence suggests the glass syringes used were contaminated with descaling liquid. Although this refers to spinal anaesthesia and I will concentrate my talk on peripheral nerve blockade, the adverse event virtually halted its use for a quarter of a century and still influences the anaesthetic community’s drive to place safety at the top of our priorities. [...]