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Before the discovery of local anesthetics, local pain control for lacerations, fractures, and minor surgery was only achieved by minimizing the pain response centrally, typically with opiates or alcohol. Local and regional anesthesia was founded on the discovery of both the modern syringe and suitable anesthetic agents. In the early 1850s, Charles Pravaz and Alexander Wood brought about the use of small glass and metallic syringes. Cocaine was isolated by Albert Neimann in 1860 and later refined into the first local anesthetic and used for ocular surgery by Carl Koller in 1884. Within 1 year, William Halsted and Richard Hall touted the use of cocaine by performing the first successful nerve block of the infraorbital plexus. The major drawbacks to cocaine, toxicity and addiction, fueled the search for alternative agents.

Procaine (Novocain®) was discovered by Alfred Einhorn in 1904 and became the local anesthetic of choice for 40 years. The short duration of action and high rate of allergic reactions was a limiting factor of procaine; prompting the search for an alternative. Lidocaine was introduced by Nils Löfgren in 1943 and continues to be the local anesthetic of choice today.1–3 A multitude of anesthetic options (Tables 40-1 and 40-2) allow the practitioner to choose the best agent for the situation at hand. Emergency medicine providers should be well versed in anesthetic techniques for a number of important and potentially painful procedures performed in the ED.4

Table 40-1 Topical Anesthetic Agents
Table 40-2 Local Anesthetic Agents

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