A Brief History of Local Anesthetics in Labor Analgesia Harry Burke MD, Sarah J. Kroh MD, Nicholas Schott MD, Ryan C. Romeo MD University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA Before local anesthetics became a mainstay in obstetric anesthesia, the concept of labor analgesia was controversial. On January 19th, 1847, a Scottish Obstetrician Dr. James Young Simpson first used diethyl ether to help a woman through labor. This was met with opposition even within the medical community. Many cited the Book of Genesis arguing that descendants of Eve were meant to suffer during labor. Other physicians of the day such as Charles Meigs, Baron Paul Dubois & Francis Ramsbotham opposed him. He would reply that it was God who “anesthetized” Adam with the birth of Eve. Despite much disapproval1, the public began to be swayed when he provided anesthesia to Queen Victoria for the birth of Prince Leopold in 1853.
It would take time for continued community acceptance and the development of neuraxial anesthetic methods. Women themselves played a crucial role in the advent of obstetric anesthesia, and as public opinion changed, they began to demand it from their physicians. Using medications such as ether, chloroform, and opioids during labor has untoward side effects. The transition to neuraxial anesthesia with local anesthetics was crucial. While James Leonard Corning, an American physician based in New York, was the first to successfully describe the methods of performing a neuraxial anesthetic with cocaine in 1885, it was Bier who performed a spinal anesthetic for intraoperative pain control with the use of cocaine in 18982. The advent of powerful local anesthetics such as amylocaine in the early 1900s prompted its use for spinal anesthesia for delivery. But it was not until the development of better surgical devices, catheters, and pumps decades later that the argument over general or neuraxial anesthesia truly began. By 1914, there were only 5 total peer-reviewed references to successful cesarean deliveries performed with spinal anesthesia.3 By the middle of the 20th century, increasing evidence supported the safety and improved obstetric outcomes with local anesthesia vs. general anesthesia. As time passed, several physicians had theorized about supplying continuous intrathecal or epidural infusions for improved pain control. In 1927, American physician Dr. George Pitkin developed a special syringe connected to a 22-gauge needle meant to deliver local anesthetics without multiple needle reinsertions.
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