1. C. Douglas Stewart, PA/C MBA Dir. of Interventional Pain Medicine Center For Pain Relief Charleston, West Virginia

2. The Beginning Leonard Corning Followed on Karl Koller’s work published in 1884 - cocaine 1885 the first neuraxial anesthetic Gave rise to the idea that it might be possible to treat pain, acute surgical pain

3. Followed on His Heels Augustus Bier About 1898 Injected his Assistant Injected 6 patients Oh, and had his assistant inject him. Mixed results

4. Next UP About 1900 Rudolph Matas Mixed Morphine and Cocaine and got more stable results

5. Grafton Love About 1935 Neurosurgeon at Mayo Clinic Developed a flexible needle And used 5fr lacquered silk Catheter Got infected Not reproducible

6. William Leonard About 1940 Philadelphia Surgeon Flexible needle and used continuous infusion

7. New Needle About 1944 Edward B. Tuohy Developed Tuohy Needle

8. The Next Few Steps Year Development Clinician 1899 Successful demonstration of spinal anesthesia (Germany) August Bier 1901 Sacral epidural local anesthetic injections to treat chronic pain (Fr) Jean-Anthanase Sicard 1921 Single-shot lumbar epidural anesthesia (Spain) Fidel Page´s-Mirave´ 1933 Single-shot lumbar epidural anesthesia (United States) Archile Mario Dogliotti 1938 Continuous lumbar epidural anesthesia (Romania) Eugen Bogdan Aburel 1944 Continuous lumbar epidural anesthesia (United States) Robert A. Hingson 1949 First report of successful continuous lumbar epidural anesthesia (US)Manuel Martinez Curbelo

9. Another Advance, The use of plastic catheters was first described by Flowers in 1949. The first polymer (plastic)was polyethylene, which had been introduced as biomaterial for epidural catheters. but why now??

10. What Happened Between 1941 and 1945? World War 2

11. Technology Boom

12. Set The Stage Manufacturing New Plastics Techniques Chemistry Better Understanding Of How Drugs Worked New Drugs NEW SCIENCE ABOUNDS

13. And The Race Is On 1960 Choh Hao Li identified beta-endorphin More work followed 1973 Candace Pert & Solomon Snyder identify opiate receptor 1977 Tony Yaksh & Thomas Rudy Study direct spinal action of narcotics in producing analgesia in rats 1979 Epidural Morphine in Treatment of Pain (10) 1981 First Report of continuous infusion of spinally administered opioiods with constant delivery pump 1982 numerous reports of improvement of both epidural and intrathecal routes constant delivery pump

14. Still Racing On 1986 High Dose Morphine Produced Hyperesthesia 1987 Chronic Intrathecal morphine for intractable pain (43) Pump Technology Grew Continuous infusion VS. Programmable Each iteration gets better

15. What’s Next I truly do not know Sets stage for where we are now