The first spinal anesthesia. Who deserves the laurels?

One year after the discovery of the anesthetic properties of cocaine, the American neurologist Corning injected the drug between the spinous processes of the lower dorsal vertebrae, first in a young dog and then in a generally healthy man. He published the results in a paper entitled "Spinal Anaesthesia and Local Medication of the Cord." For many years, there has been controversy as to whether Corning's injection was a spinal or an extradural block.

To settle this controversy, a detailed review was undertaken, in the original language, of Corning's publication, as well as of two major initial articles describing authentic spinal anesthesia, namely that by the surgeon Bier of Germany and Tuffier of France. Mention of cerebrospinal fluid, dose of injected cocaine, onset of action, and height of sensory analgesia were compared.

Corning's dose of local anesthetic was eight times higher than the doses of the same drug used by Bier and Tuffier; yet, the onset of analgesia in his patient was slower and the ultimate sensory level lower. Cerebrospinal fluid was not described in contrast to the other two publications. In addition, Corning proposed the action of cocaine to result from absorption into the venous circulation and subsequent transport to the cord.

Corning's injection was extradural, and Bier deserves the laurels for introducing spinal anesthesia.