In Genesis 2:21, God caused Adam to fall into a deep sleep; and while he was sleeping, he removed one of his ribs and closed up the place with flesh – so it would appear that anaesthesia is the oldest profession (just ahead of thoracic surgery!).

We had to wait from then until 1846 for a publication heralding the arrival of ether, ‘Insensibility during surgical operations produced by inhalation’ (recently voted as the most influential paper ever published in the 200-year history of the New England Journal of Medicine), administered by a dentist (Dr Morton) and written up by a surgeon (Dr H.J. Bigelow).

Early inhalational anaesthesia was both astonishing and flawed (imperfect operating conditions and a high mortality rate) so alternatives to general anaesthesia were continually sought.

Local anaesthesia began when Karl Koller introduced topical cocaine for eye surgery (1884) and a surgeon (August Bier) described cocaine-based spinal anaesthesia in 1898 for ankle surgery in a patient who had endured ‘severe reactions’ to general anaesthesia. Bier and his assistant Hilldebrandt had developed the technique by performing spinal anaesthesia on each other, testing their blocks with numerous kicks to the shins. Both endured very severe spinal headaches and they celebrated with large cigars! Bier described intravenous regional anaesthesia (IVRA) in 1908.

Local anaesthetic techniques are now an indispensible anaesthetic tool, used as a sole technique or as an analgesic adjunct to general anaesthesia, and they play a crucial role in enhanced recovery programmes for a number of surgical specialties. They offer the best possible analgesia with almost none of the side effects associated with opioids. They are, however, not without risk and patients have either died or been seriously injured as a consequence of these techniques, so a judgement of risk versus benefit is required every time they are employed.