The epidural procedure, a common form of pain relief, involves injecting medication near the spinal cord to block nerve signals. This method is now standard for various surgical and pain management needs, particularly during childbirth. Attributing the invention of this technique to a single individual is complex, as its history spans over half a century of sequential discoveries and refinements. The modern epidural is the result of multiple contributions from physicians who refined the technique from a risky experiment to a reliable clinical tool.
The Initial Discovery of Epidural Anesthesia
The understanding of neuraxial spaces began in the late 19th century with physician J. Leonard Corning. In 1885, Corning injected cocaine between the lower lumbar vertebrae in a dog and a human subject, demonstrating nerve function blockade. Although he intended to inject into the spinal fluid, the high dose suggests the substance likely entered the epidural space, making his experiment an early, misidentified attempt at neuraxial blockade.
The first deliberate and documented use of epidural anesthesia occurred in 1901. Two French physicians, Jean Athanase Sicard and Fernand Cathelin, independently reported using the caudal approach to access the epidural space. This method involves injecting the local anesthetic through the sacral hiatus, a bony opening at the base of the spine. Sicard and Cathelin used cocaine solutions to treat pain, advocating for this “extradural” route as an alternative to spinal injection, which carried more complications.
A significant advance came from Spanish military surgeon Fidel Pagés Miravé, who published his seminal work, “Anestesia Metamérica,” in 1921. Pagés described a technique for accessing the epidural space at the thoracolumbar level, departing from the caudal approach. This manuscript detailed the anatomy and documented surgical cases, marking the first description of a true lumbar epidural technique in humans.
Refinement and Clinical Application of the Technique
Early single-shot injections provided temporary relief, limiting their use in long procedures like surgery or labor. Italian physician Achille Mario Dogliotti addressed this technical hurdle in 1933 by describing the “loss of resistance” technique. This method, known as Dogliotti’s principle, allowed practitioners to reliably identify the epidural space by noting a sudden decrease in pressure as the needle tip passed through the dense ligamentum flavum. This principle remains a fundamental step in modern epidural placement.
The next major breakthrough involved developing a way to continuously administer the anesthetic. In 1941, Robert Hingson and colleagues pioneered continuous caudal anesthesia for obstetrics, allowing prolonged pain relief during childbirth using a needle left in the caudal space. In 1947, Cuban anesthesiologist Manuel Martínez Curbelo advanced this concept by performing the first described placement of a continuous lumbar epidural catheter.
Curbelo introduced a fine, flexible ureteral catheter through a needle into the lumbar epidural space. This method offered better control over the anesthetic spread than the caudal approach. By removing the needle and leaving the catheter, he enabled repeated injections for extended anesthesia, solving the limitations of single-shot techniques and the inconsistent results of continuous caudal blocks. His technique, which used a silk catheter and a Tuohy needle, was instrumental in making continuous epidural anesthesia practical and safe for surgery and obstetrics.
Establishing Epidurals as Standard Pain Management
Following the development of the continuous catheter technique, the epidural procedure transitioned into standard clinical practice. The 1940s and 1950s saw continuous caudal anesthesia evolve into the lumbar epidural, providing a new paradigm for obstetric pain management. Unlike previous methods that induced unconsciousness, these new neuraxial techniques allowed mothers to remain fully conscious and participate in the birth experience.
The widespread adoption of the continuous lumbar epidural was accelerated by influential figures in anesthesiology, such as John Bonica and Philip Bromage. These specialists focused on scientific study and emphasized patient safety, which was necessary for the acceptance of neuraxial techniques. As techniques became standardized and equipment, like the Tuohy needle, was refined, the procedure’s efficacy and safety profile improved significantly.
By the mid-to-late 20th century, the epidural became the preferred method for obstetric analgesia in many developed countries. Its ability to provide profound pain relief while keeping the patient awake solidified its place as the gold standard for labor and delivery pain management. This institutionalization reflects a collective medical effort over decades, transforming the initial experimental injections into one of the most common and effective forms of regional anesthesia in modern medicine.