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The History of Spinal Drug Delivery: The Evolution of Lumbar Puncture and Spinal Narcosis

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Neuraxial Therapeutics

Abstract

The history of spinal drug delivery centers around the discovery of the clinical utility of local anesthetics, opioids, and other parenteral therapeutic substances, along with the invention and evolution of equipment such as the syringe, hypodermic needle, and epidural catheter—all in the setting of an increasingly accurate understanding of spinal anatomic structures. An appreciation of the local anesthetic effects of cocaine when utilized as a topical and field infiltration agent for surgical procedures rapidly led to exploration of its clinical utility when injected into the intrathecal space. However, the limitations of lumbar intrathecal injections of cocaine as an agent for reliable and adequately long-lasting spinal anesthesia free of undesirable side effects such as drug toxicity and post-lumbar puncture headache soon dampened the enthusiasm of investigators and clinicians alike, prompting the search for more ideal drugs, equipment, and injection techniques, which continues to this day. This chapter will focus on the first 50 years of the evolution of the neuraxial delivery of therapeutics.

This chapter was originally published in Spinal Drug Delivery, Ed. Yaksh, Tony, L., Mackey, D.C., Ch. 1 The History of Spinal Drug Delivery: The Evolution of Lumbar Puncture and Spinal Narcosis, pages 1–41, Copyright Elsevier (1999) [1]. Reprinted with permission from Elsevier.

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Authors and Affiliations

  1. Division of Anesthesiology, Critical Care, and Pain, Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    David C. Mackey

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  1. (CTF-312), UC San Diego-Anesthesia Res Lab 081 (CTF-312), La Jolla, CA, USA

    Tony Yaksh

  2. University Hospital, Case Western Reserve University, Cleveland, OH, USA

    Salim Hayek

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Mackey, D.C. (2023). The History of Spinal Drug Delivery: The Evolution of Lumbar Puncture and Spinal Narcosis. In: Yaksh, T., Hayek, S. (eds) Neuraxial Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-031-39558-1_1

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