Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea.

  • Lea, Arnold William Warrington, 1867-1916.
Date:
[1901?]
Catalogue details

Licence: In copyright

Credit: Spinal anaesthesia by cocaine in gynaecology : with observations on eighteen cases / by Arnold W.W. Lea. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/18 (page 9)
    to medullary narcosis. In my series, severe headache occurred in 7 cases, and slight headache, lasting 12 to 24 hours, in 4 cases. In 7 cases no headache was present. The pain is generally occipital, hut may he frontal and accompanied by aching at the hack of the eyes. It may continue as long as three to four days after the operation (No. 9). The cause of the headache is not certainly known. It may be due to alterations in cerebro-spinal pressure, or to the gradual elimination of cocain by the brain. It does not appear to depend on the amount of fluid withdrawn by the needle, though in some cases it has been particularly severe if much fluid has been evacuated. It also follows injections of distilled water only into the subarachnoid space. The most probable cause appears to be some alteration in the cerebral circulation, but the subject is not yet worked out. Various drugs appear to relieve it.. Phen- acetin, in gr. x. doses, given immediately after the operation, diminishes or checks it; nitro-glycerin and hydro-bromate of hyoscin have also been strongly recommended. If the headache is really severe, morphia will give certain relief. In every case the headache passes away completely, and no after effects have been recorded. This method of spinal anaesthesia is not free from all risk, and mention must be made of the various complications which may possibly arise. I. Mechanical injury. The minute puncture of the mem- branes made by the needle is not likely to cause any damage to the nerve structures of the cauda equina, which float about freely in the subarachnoid space (Quincke). Even if these structures were punctured, it is not probable that any serious results would follow. It is, however, essential that the needle should have a short point. II. Sejisis. This is a real danger, and can only be avoided by scrupulous care to ensure complete asepsis of all instruments and materials used. If this method became generally adopted by those unfamiliar with aseptic technique, it is quite possible that disasters might occur. This risk, however, can be practically eliminated, and a very large number of punctures have now been made by various surgeons without any septic symptoms having