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Before the availability of local anesthetics, local pain control for lacerations, fractures, and minor surgery was achieved by minimizing the pain response centrally, typically with opiates or alcohol. Procaine, which entered clinical use in 1904, was the only local anesthetic available for almost 40 years, but the short duration of action and high rate of allergic reactions limited its effectiveness. Lidocaine was introduced in 1943 and continues to be the local anesthetic most commonly used in the ED.1,2 Additional local anesthetics are available for both topical and injectable use (Tables 36-1 and 36-2). Emergency physicians commonly use local and regional anesthetic techniques for potentially painful procedures performed in the ED.3 Regional anesthesia can also be used to control the pain of acute injuries and reduce the utilization of systemic analgesics.4,5

TABLE 36-1Topical Anesthetic Agents
TABLE 36-2Local Anesthetic Agents

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