Paternity of the Doughty technique

Correspondence in the July edition of Anaesthesia[1, 2] prompts me to comment on my recollection of the ‘Doughty’ technique that I used and taught at Kingston Hospital over 20 years ago. The basic principle was to separate the very firm force needed to drive the point of the Tuohy needle into the epidural space from the very delicate pressure applied to the plunger of the syringe to signal its entry. Figure 1 shows the syringe attached to the Tuohy needle. Strong opposing pressure is exerted between the two hands: the needle point is moved steadily towards the epidural space by the cautious but controlled relaxation of the fingers and thumb of the left hand. The syringe contains about 10 ml of fluid. The metacarpal head of the right index finger exerts minimal pressure on the end of the plunger. Loss of resistance to injection is readily perceived by the epiduralist but may be quite imperceptible to the bystander. Reflux of injected fluid is minimal. The ‘Doughty’ technique as demonstrated by Dr Doughty. From 1974 until my retirement in 1980 I used to run a one-to-one fortnight's intensive epidural course at Kingston Hospital. Both anaesthetists and obstetricians were welcomed and each participant was expected to remain ‘on-call’ for the whole time. I tried to avoid too much talking in the labour ward in the presence of mothers urgently in need of pain relief. Most of the teaching was done in my office. The first tutorial dealt with handling the syringe, Tuohy needle and epidural catheter (Fig. 1). Then came the subject of inadvertent dural puncture, with an admission of the 10 occasions on which I had been the culprit. I had a home movie showing myself as the performer plus a set of 30 slides showing the process in detail. I had a sizeable collection of slides derived from the many public lectures I had given including a paper on ‘The impossible epidural’. Shortly before my retirement, prepacked disposable epidural sets became commercially available. I did not use them because the syringes provided did not readily match my technique. Our own equipment was scrupulously cleaned and serviced on the labour wards by trained domestic staff. So much for history, but from what I have said you will not be surprised if I emphatically reject claims of paternity regarding the ‘son-of-Doughty’ techniques described by Yentis and Barnes. I fully endorse Professor Felicity Reynolds' interpretation of my technique – not surprising as she had attended the course at Kingston in the late 1970s.