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Fidel Pagés, a Spanish surgeon, tragically died in 1923 at the age of 37, just 2 years after his publication "Anestesia Metamérica," the first description of human thoracolumbar epidural anesthesia. In the intervening 100 years, epidural anesthesia has faced countless obstacles, starting with the dissemination of his initial report, which was not widely read nor appreciated at the time. However, the merits of the technique have fueled innovations to meet these challenges over the years. Even today, while epidural anesthesia is widely embraced, particularly in obstetric and chronic pain medicine, the pressures of the operating room for efficiency and a low tolerance for failure, pose modern-day challenges. Here, we revisit Pagés' original report and highlight the key innovations that have allowed for the evolution of this essential anesthesia technique., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)

Scottish obstetrician James Young Simpson first introduced the use of ether and chloroform anesthesia for labor in 1847, just 1 year after William Morton's first successful public demonstration of ether anesthesia at the Massachusetts General Hospital. The contemporaneous development of surgical anesthesia and obstetrics enabled obstetric anesthesia to address the pain of childbirth. Shortly after its introduction, obstetricians raised concerns regarding placental transport, or the idea that drugs not only crossed the placenta, but exerted detrimental effects on the neonate. The development of regional anesthesia and clinical work in obstetric anesthesia and perinatology addressed issues of the safety of the neonate, enabling obstetric anesthesia to safely and dramatically reduce the pain of childbirth., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Dr. Ryszard Rodzinski was a Polish surgeon who, in spite of his short life, had a productive career. His most important discovery was a safer method of performing regional anesthesia for abdominal surgery. The first description of combined spinal epidural anesthesia is generally attributed to Soresi in 1937. In the early 20th century, Rodzinski invented a novel technique, "combined lumbosacral anesthesia," which combined lumbar spinal anesthesia and sacral epidural anesthesia. During the 19th Meeting of Polish Surgeons in July 1922 in Warsaw, Rodzinski presented an article entitled "On Combined Lumbosacral Anaesthesia," in which he described this technique used in surgical clinic in Lwów since October 1921. Given this presentation, Rodzinski could be considered to have made the first known presentation of the combined spinal and epidural anesthesia., (Copyright © 2016 Anesthesia History Association. Published by Elsevier Inc. All rights reserved.)

The aim of this paper is to link the history of the Multicentre Australian Study of Epidural Anaesthesia in high risk surgery, the MASTER Trial, the first National Health and Medical Research Council (NHMRC) funded multicentre randomised clinical trial in Australia led by anaesthetist researchers, and the decision of The Australian and New Zealand College of Anaesthetists (ANZCA) to establish a clinical trials network, in 2003, to the success of contemporary researchers in Australia and New Zealand in anaesthesia and perioperative medicine.

In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique., (© Georg Thieme Verlag Stuttgart · New York.)

Epidural catheters have evolved during the past several decades, as clinicians and manufacturers have sought to influence the quality of analgesia and anesthesia and reduce the incidence of catheter-related complications. This evolution has allowed a transformation from single-shot to continuous-infusion techniques and resulted in easier passage into the epidural space, more extensive medication distribution, and ultimately, improved patient satisfaction. Particular catheter features, including the materials used, tip design, and orifice number and arrangement, have been associated with specific outcomes and provide direction for future development.

Unlabelled: Francis G. Ruston MD CITATION: Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954: 1: 37-44., Purpose: The author describes the use of single-shot epidural anesthesia in a series of 44 infants and children. The patients were anesthetized in hospitals in Hamilton, Ontario from 1949 until the time of publication in 1954. The study aimed to describe the indications and efficacy of this technique as well as any apparent complications. A detailed description of the management of these patients was given, including many tips and suggestions that are still applicable in 2013., Principal Findings: Seventy-seven infants and children received epidural anesthesia for a variety of procedures, particularly for pyloric stenosis. Forty-four of the procedures were carried out by the author. All patients survived, apart from one child who died of recurrent intestinal obstruction unrelated to the anesthetic. It was found, after some experience, that the sitting position was preferable for epidural needle insertion. Use of the hanging drop technique for identification of the epidural space proved to be simple and reliable. Surgical conditions were found to be excellent and relaxation was profound; however, some sedation was often required to obtain optimal conditions for surgery. The surgeons became sold on the technique and began to request an epidural on a regular basis., Conclusions: Epidural anesthesia in infants and young children is effective for a variety of procedures below the diaphragm, even in moribund patients.

The historical narrative is a story told to illustrate a point, however subconsciously. The "giants" of obstetric anesthesia -- Simpson, Snow, Apgar -- and countless other less well-known physicians all contributed to the history of obstetric anesthesia. We remember them by retelling this history to illustrate elements of professionalism and how we as a profession wish to act. The Physician Charter is an excellent first approximation of a workable definition of this quality, which can and does change over time. By using the three principles and 10 professional responsibilities as a template, the past comes alive as a teaching method to each and every obstetric anesthesiologist.

Objectives: To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists., Methods: We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia., Results: In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V Sagarra Lascurain, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia.

Combined spinal and epidural anaesthesia/analgesia is a method whereby drugs are applied intrathecally as a single dose and epidurally either continuously or intermittently via an epidural catheter. More than 50 years ago, first attempts were made to introduce this method into clinical practice but they found little general acceptance. Only during the last decades has tremendous progress been made in developing new, highly-sophisticated equipment: matching spinal and epidural needles and catheters, epidural needles with a separate conduit for the spinal needle or with an additional hole for the exit of the spinal needle as well as fixation devices for the spinal needle. A specific feature of the method is the only recently recognised epidural volume extension, which allows the use of low-dose drug combinations with sufficient analgetic properties but less cardiovascular compromise and fewer side-effects. This review describes the main and most important developmental steps and offers practical examples for its use in day-case surgery of the lower limb, in the "walking epidural" in obstetrics and in caesarean section. The method has become a valuable new tool in the armamentarium of the anaesthetist and part of daily routine in many clinics.

Fidel Pagés Miravé (1886-1923) was a well-known Spanish military surgeon and among the first in the world to pioneer lumbar epidural anesthesia in 1920. Between 1931 and 1936, surgeons of various nationalities spread the use of lumbar epidural anesthesia worldwide. This second debut of metameric anesthesia has given us amusing anecdotes and stories of singular old- and new-world personalities who left a wealth of literature that deserves to be reviewed and valued. This review will use their original words and idiomatic expressions which, though archaic, have beauty and significance. Special emphasis is put on dates in comparisons. Because well-known names have been associated with lumbar epidural anesthesia, this review closes with the biographies of illustrious European and Latin American surgeons who played a major role in spreading the technique in the United States of America and other parts of the world.

The history of intrathecal and epidural anaesthesia is in parallel with the development of general anaesthesia. As ether anaesthesia (1846) is considered the first modern anaesthetic since its use by Morton 157 yr ago, so Bier made history by using cocaine for intrathecal anaesthesia in 1898. The first published report on opioids for intrathecal anaesthesia belongs to a Romanian surgeon, Racoviceanu-Pitesti, who presented his experience at Paris in 1901. It was almost a century before the opioids were used for epidural analgesia. Behar and his colleagues published the first report on the epidural use of morphine for the treatment of pain in The Lancet in 1979. Epidural and intrathecal opioids are today part of a routine regimen for intra- and postoperative analgesia. Over the last 30 yr, the use of epidural opioids has became a standard for analgesia in labour and delivery, and for the management of chronic pain. Finally, epidural opioids have been shown to have a pre-emptive effect, when used before major surgery. We present the evolution of neuraxial anaesthesia and the history of intrathecal and epidural administration of opioids.

Implications: In this article we discuss the development of epidural needles and the historical factors leading to their invention. The most popular needles are described and their inventors acknowledged.

Epidural anesthesia is used for relief of labor pain by 29% of women having hospital deliveries in the United States, a number that has doubled within the past 10 years. Although epidurals provide objective pain relief that is exponentially better than the other pain relief methods, there are many purported complications and side effects. This article reviews how epidurals work, summarizes the literature regarding complications, and presents some of the ethical dilemmas inherent in the use of this technology for labor.

Fidel Pagés was born in Huesca on the 26th of January 1886. He completed his secondary studies in the same city, later receiving his degree in medicine and surgery from University of Zaragoza (1908) with high honors. The same year he joined the army medical corp, to be sent to serve in Melilla in 1909 with a rank of second medical officer. After being promoted in 1911 to first medical officer, he served in Tarragona, Toledo, Madrid (where received his doctoral degree), Ciudad Real, and once again in Madrid. In 1913 Pagés married and was destined to Mahón, only to return to work at the War Ministry in Madrid in 1915, after a brief sojourn in Alicante. The same year he placed first in competition for a staff position at Madrid's Hospital Provincial. In 1917, during World War I, he inspected POW camps in Austria and Hungary, while also serving in the military hospital in Vienna. In 1919 he became the founding editor of Revista Española de Cirugía, which published "Anestesia metamérica" in 1921, simultaneous to its publication in Revista de Sanidad Militar. In 1920 on he was assigned to Madrid's Hospital Militar de Urgencia, but was also briefly sent to Melilla in 1921 as a consequence of the military "Disaster at Annual". In 1922 he was promoted to the rank of Medical Commandant. On the 21st of September 1923, Pagés died in a traffic accident while returning to Madrid from San Sebastián. His work was soon forgotten, as can be seen from the credit long given to the Italian surgeon Dogliotti for the discovery of epidural anesthesia. Only with passing time, and through the effort of Argentinian and Spanish physicians, has the world come to recognize Pagés as the original author of this technique.

Unlabelled: Combined spinal epidural anaesthesia (CSE) offers the fast and profound neural blockade of spinal anaesthesia, but provides the possibilities of extension of the block and post-operative pain control. On the basis of a historical review, the advantages and drawbacks of CSE are discussed, and purpose-designed needles (Eldor 1 and 2, E-SP, T-A, Braun, Mediziv) are described. The dosage problems inherent in the technique and a possible solution to the "test dose" question are described., In Conclusion: CSE is a valuable alternative to established regional anaesthetic techniques. The Mediziv needle offers several advantages, but a comparative study of the different needle types is needed.

The application of opioids in the proximity of the spinal cord is a recent addition to the forms of treatment available for pain relief. During the last 20 years we have learned more about the intimate mechanisms of the action of opiates then we had in the preceding 5 millennia. Opium, in fact, has been used for medical purposes from prehistoric times. On the basis of the newly acquired knowledge, we are now applying opioids in more effective ways and providing more patients with long overdue relief of their pain.