The Centennial of Spinal Anesthesia

Abstract

(Wulf) Lecturer in Anesthesiology.ON August 16, 1898, August Bier (1861–1949) performed the first operation with spinal anesthesia at the Royal Surgical Hospital of the University of Kiel, Germany. The patient, a 34-yr-old laborer, was to undergo resection of a tuberculous ankle joint, but he had suffered severe adverse effects from previous general anesthesia. Therefore, Bier suggested giving “cocainization of the spinal cord” a try. He injected 15 mg of cocaine intrathecally before performing the operation. Intraoperatively the patient felt no pain at all. Some vomiting and headache were present after surgery, but the adverse effects were minimal compared with the patient's previous experience.Without doubt, this event was a milestone of the history of our specialty. Spinal anesthesia was the first major regional technique introduced into broad clinical practice. The only local anesthetic techniques to precede it were topical anesthesia of the eye (Carl Koller in 1884 [1]) and infiltration anesthesia (Carl-Ludwig Schleich in 1892 [2]). Other regional techniques, such as axillary or supraclavicular brachial plexus block (Georg Hirschel [3]and D. Kulenkampff [4]in 1911), were first described many years later. Spinal anesthesia was introduced into clinical practice even before the breakthrough of orotracheal intubation (Franz Kuhn in 1901 [5]).The original paper written by August Bier (1899 [6]) is not only part of our anesthesiology heritage - it is also fascinating reading (an English translation of Bier's original manuscript is found as an appendix to this report). It contains marvelously detailed descriptions of the first six patients operated on under spinal anesthesia, of the experiments Bier performed on himself and on his colleague Hildebrandt, and of further clinical experience regarding spinal anesthesia. It is interesting to note that Bier did not start with the “self-experiment,” as often stated, but rather used the “self-experiment to further investigate some of the problems he encountered with the first administration in patients. Many specific points in Bier's description of spinal anesthesia are still pertinent 100 years later:- Spinal anesthesia will only succeed if there is at least some backflow of cerebrospinal fluid.Post-dural puncture headache is the most common problem after spinal anesthesia.- Post-dural puncture headache is probably related to the amount of cerebrospinal fluid lost.Karl August Bier was born on November 24, 1861 in Helsen, a small village in the center of Germany. He studied medicine in Berlin, Leipzig, and Kiel. His most important clinical lecturers in Kiel were Friedrich von Esmarch and Heinrich Quincke:- Friedrich von Esmarch (1823 - 1908) was one of the most famous surgeons of his time. Among his achievements were the invention of a technique (