Local Anaesthesia was developed in Germany one century ago

A Aldo Mottura, MD

In the eighteenth century, the operations were performed under the use of gases like chloroform or ether but the mortality rate was high. Therefore, surgeons were interested in finding other kinds of harmless anaesthesia.

In 1860 in Göttingen Albert Niemann reported the anaesthetics properties of cocaine, a drug obtained from a Peruvian Bush. When an ophthalmologist from Vienna named Carl Koller had an inflammatory process in his gums, his friend Sigmund Freud who knew about this report, used cocaine to relieve his pain. After this experience, Koller performed the first cataracts surgery in 1883 using cocaine with great success. Koller first and then all ophthalmologists in the word began to use cocaine for corneal operations.

Old reports show that since 1880 Maximilian Oberst, in Halle, had been operating patients injecting cocaine under the skin while an assistant was compressing the veins to avoid the rapid absorption of the cocaine toxic effects. Some other German surgeons were using cocaine under the skin for minor surgeries, however some cases of overdose and fatal outcomes were also reported. In 1890, Karl Schleich, a German surgeon from Berlin, in "The German Congress of Surgeons" demonstrated the anaesthetic properties of different dilutions of cocaine to perform surgeries in order to avoid toxic doses. The era of the using of large dilution of anaesthetics had began.

Prof.Dr.Carl Ludwig Schleich,

Berlin 1859-1922

William Halsted, an American surgeon, son of a Germany family, was at that time in Berlin and learnt from the Germans the use of cocaine as local anaesthesia. He took back this practice to America and began to use cocaine at the John Hopkins Hospital in Baltimore.

In 1905 a synthetic alkaloid similar to the cocaine named Novocain but with less toxic effects, was developed by A. Einhorn in the Hoechst laboratories in Darmstadt. From then on, new less toxic anaesthetics were used for local anaesthesia and big surgeries could therefore be performed. When Takamine and Aldrich in the Park Davis laboratories in London developed the Suprarenine (named later Adrenaline), and its vasoconstrictive effects, a surgeon from Heidelberg named Heinrich Braun adopted this drug and began to use it in combination with the Novocain to avoid the bleeding and the absorption of the anaesthetics. In 1905 he published his first book that had 7 re-editions later and was a complete compilation of all sort of local anaesthesia for almost all sorts of surgeries. He was recognized as "the father of the local anaesthesia"

Prof. Dr. Heinrich Braun,

Herberlingen 1862-1934

Carl Gross a German surgeon also reported the action of local anaesthetics would last longer if they were diluted in a saline solution. As we can see a very old idea that was rediscovered at the end of the last century. Läwen in 1910 experimented on himself with Novocaine diluted in a bicarbonate solution reporting that he obtained this way a more rapid and lasting effect of anaesthetics. Anaesthetics diluted in saline solutions was also rediscovered under an American name and its use is now very popular in plastic surgery.

Concerning the methods of injection, Moskowicz in 1901 replaced the syringes for injecting anaesthetics, for an infusion bottle filled with anaesthetic solution that was later perfected by Kirschner in 1931 when he developed a device that was using carbon anhydride gas, facilitated the infiltration under pressure, witch he named "Hochdruckanästhesierungsapparat". Different devices powered by an electric motor driven or using the principle of the bottle are largely used nowadays in plastic surgery.

Today, many plastic surgeons perform different surgeries under local anaesthesia like rhynoplasties, face lifts, breast surgeries, liposuction and some lipectomies but it has to be remembered that the idea to perform surgeries under local anaesthesia, new anaesthetics, vasoconstrictors, large anaesthetics dilutions, alkaline anaesthetics solutions, devices for infiltrations and almost all that is used today in plastic surgery in the world, was developed or described at the end of the eighteenth century and at the beginning of the nineteenth century by the Germany surgeons. These pioneers German surgeons should not be forgotten.

Antonio Aldo Mottura, MD

Av. Friuli 2110

B° Colinas de Vélez Sarsfield

5016 CÓrdoba, Argentina

Tel: ++54 351 460 7071

e-mail: amott@esteticamottura.com