History of Interventional Pain Procedures

History of Interventional Pain Procedures

Serdar Erdine MD, FIPP1 and Peter S. Staats MD, MBA2

1 Medical Faculty of Istanbul University, Istanbul Pain Center, Istanbul, Turkey
2 World Institute of Pain, Atlantic Beach, FL, USA


Interventional pain management dates back to the origins of neural blockade and regional analgesia [1]. The invention of the hollow needle and syringe may be accepted as the first step in the history of interventional pain procedures. Sir Francis Rynd performed the first nerve block using morphine dripped through a cannula in a patient with trigeminal neuralgia in The Meath Hospital in Dublin, in 1844 [2].

Alexander Wood improved the hollow needle in 1853 and Charles Pravaz, the hypodermic syringe, known as the Pravaz syringe, in 1853 [3] (Figures 2.1 and 2.2).

Figure 2.1 The Pravaz hypodermic syringe.

Figure 2.2 Alexander Wood (1817–1884).

The origins of the neural blockade and regional anesthesia date back to 1884. Although Freud and Koller were working together on cocaine, Karl Koller is accepted as the father of regional anesthesia as he was the first to publish the local anesthetic effect of cocaine for eye surgery. Koller was just 27 years old [4] (Figures 2.3 and 2.4).

Figure 2.3 Sigmund Freud (1856–1939).

Figure 2.4 Karl Koller (1857–1944).

In 1899, Tuffer described the use of spinal cocaine to control pain from sarcoma of the leg [5]. It soon became apparent that cocaine was a very toxic substance, and between 1884 and 1891, 200 cases of toxicity had been reported and as many as 13 deaths had occurred [6].

Caudal Block

Sicard first described injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901 to treat patients suffering from severe, intractable sciatic pain or lumbago [7]. Cathelin also described caudal administration of local anesthetic not only for surgical procedures, but also for the relief of pain due to inoperable carcinoma of the rectum [8]. Pasquier and Leri, in 1901, independently reported the use of caudal epidural injection for sciatic pain [9].

After 1952, corticosteroid was added to the local anesthetic for acute and chronic pain by Robecchi and Capra in 1952 and Lievre in 1957.

Spinal Subarachnoid Approaches

Leonard Corning, a neurologist, was the first person to perform spinal anesthesia, but apparently was not fully aware that he had done so at the time. He injected 1.18 mL of 2 % cocaine hydrochloride into the space “situated between the spinous processes of two inferior dorsal vertebrae” on a dog. He carried out a similar test on a human being and the same happened, whereby he concluded that cocaine was absorbed by the veins and “then transferred to the substance of the cord and gave rise to anesthesia of the sensory and perhaps motor tracts of the same” [10].

Corning published one of the first textbooks on Local Anesthesia in 1886, and the first textbook on pain in 1894 [11, 12] (Figure 2.5).

Figure 2.5 James Leonard Corning (1855–1923).

Discovery of Spinal Anesthesia by August Bier

The first spinal anesthesia in a human was performed by August Bier in 1899 [13]. He used 10–20 mg of cocaine and the first of these experiments was carried out on August, 16, 1898. He asked his colleague Hildebrandt to perform spinal anesthesia on him. Hildebrandt was not successful. Then Bier successfully performed a lumbar puncture on his colleague and injected 5 mg of cocaine and obtained a very satisfactory spinal block. Both suffered headaches, nausea, and vomiting as well as dizziness as a result of CSF leakage and this was relieved by laying down. This is the first case report of post-dural puncture headache (Figures 2.6 and 2.7).

Figure 2.6 August Bier on his 75th birthday in 1936.

Figure 2.7 August Bier performing spinal anesthesia in 1920.

Epidural Anesthesia

Sicard and Cathelin injected cocaine into the epidural space caudally in 1901 [7, 14]. Fidel Pages-Mirave described the lumbar approach to the epidural space in 1923 [15]. Dogliotti popularized the technique in the 1930s when he described the “loss of resistance technique” [16] and Curbelo introduced continuous epidural anesthesia in 1949 [17] (Figures 2.8 and 2.9).

Figure 2.8 Jean-Athanase Sicard (1872–1929).

Figure 2.9 A.M. Dogliotti (1897–1966).

Cervical epidural block was also defined by Dogliotti in 1933.

Radiofrequency Procedures

Use of radiofrequency (RF) procedures for the treatment of chronic pain dates back to 1931 by Kirscher where he used a direct current of 350 mA with a 10-mm uninsulated needle, for the treatment of trigeminal neuralgia [18].

Sweet wrote his famous article in 1953, together with Vernon Mark, showing that the use of very high-frequency current (in the RF range) has decisive advantages over direct current lesion procedures [19].

Bernard J. Cosman made parallel pioneering contributions to the design and engineering of RF lesion generators and electrodes [20] (Figure 2.10).

Figure 2.10 Bernard J. Cosman (1914–1993).

The use of RF in pain management dates back to 1965 by Rosomoff for percutaneous lateral cordotomy to treat unilateral pain in cancer patients [21].

The first use of RF current for spinal pain was reported by Sheally, who performed RF lesioning of the medial branch for lumbar zygapophyseal joint pain in 1975 [22].

In 1980, a very important development was the use of small-diameter electrodes, known as the Sluijter Mehta Kit (SMK) system, which were introduced for the treatment of spinal pain by Slujter and Mehta. The system consists of a 22-gauge (22G) disposable cannula with a fine thermocouple probe inside for temperature measurement. The smaller electrode size diminished discomfort during the procedures [23].

Pulsed RF was developed, in part, as a less destructive alternative to CRF and was introduced by Menno Slujter in 1998 [24] (Figure 2.11 ).

Figure 2.11 Menno Slujter (1933–).

Historical Background by Procedure

1) Gasserian ganglion blocks

In 1903, Schloesser was the first to report the use of alcohol injection into the peripheral nerves in the treatment of trigeminal neuralgia [25].

Härtel, in 1914, described the percutaneous insertion of a needle through the foramen ovale via an extraoral approach, which is still used today [26].

In 1974, Sweet and Wepsic introduced RF lesioning of the trigeminal rootlets in the Meckel cave [27] (Figure 2.12).

Figure 2.12 W.H. Sweet (1891–2001).

In 1981, Hakanson introduced percutaneous retrogasserian glycerol chemoneurolysis [28].

In 1983, Mullan and Lictor, introduced the technique of percutaneous balloon compression of the gasserian ganglion [29].

2) Glossopharyngeal block

Weisenburg first described pain in the distribution of the glossopharyngeal nerve in a patient with a cerebellopontine angle tumor in 1910. In 1921, Harris reported the first idiopathic case and coined the term glossopharyngeal neuralgia. He suggested that blockade of the glossopharyngeal nerve might be useful in palliating this painful condition. Early attempts at permanent treatment of glossopharyngeal neuralgia and cancer pain in the distribution of the glossopharyngeal nerve consisted principally of extracranial surgical section or alcohol neurolysis of the glossopharyngeal nerve.

3) Sphenopalatine ganglion block

The spehnopalatine ganglion (SPG) has been involved in the pathogenesis of pain since Sluder first described sphenopalatine neuralgia in 1908 and treated it with an SPG block.

4) Occipital nerve block

The term “occipital neuralgia” was first used in 1821, by Beruta y Lentijo and Ramos. The technique of occipital nerve block seems to have been first described by Bonica in 1953.

Brachial Plexus Block

Halsted performed a brachial plexus block in a patient in the United States in 1884; the same year in which Koller used cocaine [30] (Figure 2.13).

Figure 2.13 W. Halstead (1852–1922).

Celiac Plexus Block

In 1912, Kappis described paravertebral somatic blocks for surgery and pain relief [31]. In 1922, Läwen used paravertebral somatic block in the diagnosis of abdominal disease [32]. Celiac plexus block was first described by Braun, utilizing an anterior surgical approach in 1906, followed by Kappis in 1914, utilizing a posterior approach [33]. In 1920, Gaston Labat modified the technique of Kappis [34].

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Oct 30, 2022 | Posted by in ANESTHESIA | Comments Off on History of Interventional Pain Procedures

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