Chapter 44
- Nerve Blocks
- Denise J. Wedel
- Terese T. Horlocker
The techniques of peripheral neural blockade were developed early
in the history of anesthesia (see Chapter
1
). The American surgeons Halsted and Hall[1]
[2]
described the injection of cocaine into peripheral
sites, including the ulnar, musculocutaneous, supratrochlear, and infraorbital nerves,
for minor surgical procedures in the 1880s. James Leonard Corning[3]
recommended the use of an Esmarch bandage in 1885 to arrest local circulation, prolonging
the cocaine-induced block and decreasing the uptake of that local anesthetic from
the tissues. This concept was furthered by Heinrich F.W. Braun,[4]
who substituted epinephrine, a "chemical tourniquet," in 1903. Braun[5]
also introduced the term conduction anesthesia in
his 1905 textbook on local anesthesia, which described techniques for every region
of the body. In 1920, the French surgeon, Gaston Labat, was invited by Charles Mayo
to teach innovative methods of regional anesthesia at the Mayo Clinic. During his
appointment there, Labat authored Regional Anesthesia: Its
Technic and Application.[6]
The book
was considered to be the definitive text on regional anesthesia for at least 30 years
after its publication. Labat's textbook focused on the intraoperative management
of patients undergoing intra-abdominal, head and neck, and extremity procedures using
infiltration, peripheral, plexus, and splanchnic blockade; neuraxial techniques were
not widely applied at the time.
Peripheral blockade remains a well-accepted component of comprehensive
anesthetic care. Its role has expanded from the operating suite into the arena of
postoperative and chronic pain management (see Chapter
72
and Chapter 73
).
With appropriate selection and sedation, these techniques can be used in all age
groups. Skillful application of peripheral neural blockade broadens the anesthesiologist's
range of options in providing optimal anesthetic care.
