c. douglas stewart, pa/c mba dir. of interventional pain medicine center for pain relief charleston,...
TRANSCRIPT
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A Brief History of Intrathecal Therapy
C. Douglas Stewart, PA/C MBADir. of Interventional Pain Medicine
Center For Pain ReliefCharleston, West Virginia
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The Beginning Leonard CorningFollowed on Karl Koller’s work published in 1884 - cocaine1885 the first neuraxial anestheticGave rise to the idea that it might be possible to treat pain, acute surgical pain
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Followed on His HeelsAugustus BierAbout 1898Injected his
AssistantInjected 6 patients Oh, and had his
assistant inject him.Mixed results
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Next UPAbout 1900Rudolph MatasMixed Morphine and
Cocaine and got more stable results
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Grafton LoveAbout 1935Neurosurgeon at Mayo ClinicDeveloped a flexible needleAnd used 5fr lacquered silk CatheterGot infectedNot reproducible
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William LeonardAbout 1940Philadelphia SurgeonFlexible needle and used continuous infusion
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New NeedleAbout 1944Edward B. TuohyDeveloped Tuohy
Needle
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The Next Few Steps
Year Development Clinician1899 Successful demonstration of spinal anesthesia (Germany) August Bier1901 Sacral epidural local anesthetic injections to treat chronic pain (Fr) Jean-Anthanase Sicard1921 Single-shot lumbar epidural anesthesia (Spain) Fidel Page´s-Mirave´1933 Single-shot lumbar epidural anesthesia (United States) Archile Mario Dogliotti1938 Continuous lumbar epidural anesthesia (Romania) Eugen Bogdan Aburel1944 Continuous lumbar epidural anesthesia (United States) Robert A. Hingson1949 First report of successful continuous lumbar epidural anesthesia (US)Manuel Martinez Curbelo
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Another Advance,
The use of plastic catheters was first described by Flowers in 1949. The first polymer (plastic)was polyethylene, which had been introduced as biomaterial for epidural catheters.
but why now??
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What Happened Between 1941 and 1945?
World War 2
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Technology Boom
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Set The StageManufacturing
New PlasticsTechniques
ChemistryBetter Understanding Of How Drugs WorkedNew Drugs
NEW SCIENCE ABOUNDS
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And The Race Is On1960 Choh Hao Li identified beta-endorphin
More work followed1973 Candace Pert & Solomon Snyder identify opiate
receptor1977 Tony Yaksh & Thomas Rudy Study direct spinal
action of narcotics in producing analgesia in rats1979 Epidural Morphine in Treatment of Pain (10)1981 First Report of continuous infusion of spinally
administered opioiods with constant delivery pump1982 numerous reports of improvement of both
epidural and intrathecal routes constant delivery pump
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Still Racing On1986 High Dose Morphine Produced
Hyperesthesia1987 Chronic Intrathecal morphine for
intractable pain (43)Pump Technology GrewContinuous infusion VS. ProgrammableEach iteration gets better
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What’s NextI truly do not knowSets stage for where we are now