Spinal analgesia : development and present status of the method : with brief summary of personal experience in 1,065 cases / William Seaman Bainbridge.

  • Bainbridge, William Seaman, 1870-1947.
Date:
1912
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Licence: In copyright

Credit: Spinal analgesia : development and present status of the method : with brief summary of personal experience in 1,065 cases / William Seaman Bainbridge. 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.

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    and tropacocain are the drugs most generally used, with stovain, perhaps, in the lead. Other drugs than cocain having been found available for spinal analgesia, attention was next directed toward making such combinations of these with other substances as to ■ render the solution heavier or lighter than the cerebrospinal fluid, the object being to avail oneself of gravity in controlling the height of the analgesia. Experimentation along this line has led to some very interesting results, and has evolved three general classes of solutions : (1) those of lighter specific weight than the cerebrospinal fluid; (2) those of approximately equal weight; (3) those of heavier weight. To the first class belongs the so-called “diffusible” solution employed by Babcock, in which alcohol is used to render the fluid lighter than the cerebrospinal fluid. To the second class belong the simple solutions of the analgesic agent with water, with water plus cerebro- spinal fluid, with cerebrospinal fluid alone, or with normal salt solution. To the third class belong the so-called “non-diffusible” solutions, which are rendered heavier than the cerebro- spinal fluid by the addition of glucose, dextrin or gum arabic. To any of these solutions may be added, if desired, epinephrin or some similar product, as employed by Bier, Gray and many others, or strychnin, as suggested by Jonnesco. In 988 of my 1,065 cases simple solutions, of the second class, were employed, the agent being sterilized after the manner described, and dissolved in plain sterile water, without the addition of any other drug. In over 500 of the 988 cases cocain was used. In the remainder the various other agents and combinations were employed. I now use, as a rule, stovain or tropacocain, because fewer unpleasant symptoms are apt to ensue, but I do not hesitate to employ cocain. In the 1,065 cases there was one death (with the diffusible stovain solution, probably due to status lym- phaticus) ; one case of temporary partial paralysis with complete recovery;2 one case of failure due to so-called “dry spine,” in which puncture at different levels failed to bring cerebrospinal fluid; two cases with alypin, in which there was considerable respiratory depression, and