INTRODUCTION OF REGIONAL ANESTHESIA

Early Attempts at Local Anesthesia

The successful development of local anesthesia began in the late 19th century, but the idea of preparing a regional area of reduced sensibility before surgical incision was evident in earlier surgical writings. Ambroise Paré (1510–1590), the noted military surgeon, observed that squeezing a limb before amputation reduced the pain from incision.^[131] Benjamin Bell^[205] (1749–1806), surgeon to the Royal Infirmary, Edinburgh, described the use of a nerve compressor to reduce pain during amputations in his textbook dated 1796. Napoleon's chief military surgeon Dominique J. Larrey (1766–1842) described performing amputations in cold environments (-19°C) when assistants were nearly unable to hold the instruments. He found it remarkable that under these conditions there was less pain and that the patients recovered rapidly.^[131]

In 1876, Benjamin Ward Richardson (1828–1896) observed that rapid evaporation of volatile fluids produced local cooling and insensibility of the underlying skin, and this became the basis for ether (and later ethyl chloride) spray.^[206] In his 1864 textbook, Samuel Gross ^[207] (1805–1884), described local anesthesia produced by the topical application of a mixture of ice and salt, but he found it useless after the first few minutes after incision. The phrase freeze the skin is the only contemporary reminder of this early practice.