Locoregional Anaesthesia in High Risk Patients

  • W. K. Ilias
Conference paper


Although the introduction of ether for general anaesthesia did revolutionize surgical performance (W. Mortimer, Oct. 16th 1846), it has to be realized, however, that in the past uncontrollable serious side effects [1] limited its general application and doctors continuously looked out for alternate methods. It needed further 38 years until K. Koller (Sept. 11th 1884) successfully used topical cocaine for ophtalmie surgery and Halsted together with Hall used cocaine for regional block of the ulnar nerve (1884). The further development of local anaesthesia is strictly connected to personalities such as Cushing, Schleich [2], who invented injection techniques as well as special drug mixtures (Schleich II solution: 0.05 Cocaine, 0.01 Morphine ad 200 ml 7.5% NaCl solution), and Lennander who realized the importance and peculiarity of visceral nociception [3]. Special attention should be given to the fact, that Schleich’s solution II included morphine for local application, since he and his predecessors believed in the local analgesic effects of opioids, which has recently been proven [5]. Despite the introduction of epinephrine in local anaesthesia by Braun [4], which had, been successfully used to prolong cocaine induced local anaesthesia, the real big step to “local anaesthesia” did not take place, since also this additive was not sufficient to provide analgesia for longer lasting surgical procedures.


Epidural Anaesthesia Interstitial Cystitis Ureteral Catheter Brachial Plexus Block Continuous Spinal Anaesthesia 
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© Springer-Verlag Italia 1997

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  • W. K. Ilias

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