By Michael J. Cousins AM MB BS MD (SYD) FAN, Phillip O. Bridenbaugh MD, Daniel B. Carr MD DABPM FFPMANZCA(Hon), Terese T. Horlocker MD
This finished, authoritative textual content offers the clinical foundations and medical perform of neural blockade in either nearby anesthesia and the administration of ache. The descriptions and illustrations of ache mechanisms are thought of vintage examples. The Fourth variation has been subtle for readability and flows logically from rules and pharmacology, to options for every anatomic sector, to purposes. This variation has new co-editors and a number of other new chapters on themes together with neurologic issues, neural blockade for surgical procedure, remedy of discomfort in older humans, and issues in ache medication.
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Additional resources for Cousins and Bridenbaugh’s Neural Blockade in Clinical Anesthesia and Pain Medicine
He injected 10 mg of cocaine at the L4–L5 level, in five parturients, and claimed that this alleviated pain with little impairment of muscular power or uterine motility; however, he recommended the method particularly for forceps delivery. S. Marx (82) in the United States quickly followed with several reports praising the ability of lumbar cocainization to still “the agonizing and maniacal shrieks of these poor women” for 1 to 5 hours, without cessation of uterine contractions; spontaneous bearing down was eliminated, although when told to do so the patient was capable of bringing her abdominal muscles into play as powerfully as under normal conditions.
Schleich’s interest in infiltration anesthesia appeared to stem from the poor effects that often followed general anesthesia in that era. Schleich stated: “For however great the improvement that our methods in the treatment of narcosis may undergo in the course of time, it will always remain a dangerous and uncertain interference with the brain mechanism, the working of which we are unable to fathom . . ” Schleich applied the principle that pure water has a weak anesthetic effect but is painful on in- jection, whereas physiologic saline is not.
LOCAL ANESTHETICS The toxicity of cocaine, coupled with its vast potential for usefulness in surgery, led to an intensive search for less toxic substitutes. However, decreased toxicity without increased irritancy—or impractically brief effectiveness—proved elusive until the synthesis of procaine (Novocaine) by Einhorn in 1904. No specific report to that effect appears in the literature, so it fell to the lot of the surgeon Heinrich Braun to make the report in 1905, along with descriptions of two other agents, stovaine and alypin (44).