Neuraxial anaesthesia (neuraxial blockade) refers to local anaesthetic techniques delivered around the spinal cord and nerve roots, principally spinal anaesthesia (intrathecal/subarachnoid) and epidural anaesthesia (extradural/peridural, including caudal). Modern practice relies on distinct confirmation endpoints: intrathecal placement is confirmed by free cerebrospinal fluid (CSF) flow, whereas epidural placement is inferred from loss-of-resistance and related indirect signs (including hanging-drop and pressure-based methods).
Historically, neuraxial techniques advanced alongside innovations in needle design, catheter placement, and reproducible methods for identifying anatomical planes. The eponym landscape reflects this.
Some terms remain precise (e.g. Quincke and lumbar puncture), while others have drifted into generic usage (e.g.
“Tuohy” often used as shorthand for many epidural needle designs despite later modification and variation). Clinically, neuraxial blockade remains central to obstetrics, perioperative analgesia, and pain medicine.
Its evolution is a recurring story of practical problems such as block reliability, post-dural puncture headache (PDPH), catheter direction and dosing control. These drive successive solutions from early caudal injections to continuous catheter epidurals and directional needle tips designed to guide catheters.
LITFL published a clinical update in Critical Care on 03 Mar 2026.
The item focuses on History of Neuraxial Anaesthesia.
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