Hadzic's Regional Anesthesia >Tony Tsai, MD, Jeffrey Gadsden, MD, Cliff Connery, MD

Local Infiltration Anesthesia: Introduction

"Many procedures can be performed with the use of local anesthetic alone, instilled at or near the site of surgery. Often this can be done by the surgeon without the use or assistance of an anesthesiologist. Local infiltration is also technically easy to perform and requires minimal postoperative care. Together, these factors contribute to its popularity and nearly ubiquitous application as a means of anesthesia for small minimally invasive procedures and operations. This technique is relatively safe as well, but does require an understanding of basic local anesthetic pharmacology, especially with respect to dosing and toxicity, as well as skill for successful application.There are several references throughout history of efforts to produce local anesthesia by various means.¹ Ancient Egyptians believed that the fat of the crocodile could induce anesthesia if placed on the skin of a patient. The same people also believed that the stone of Memphis could produce local anesthesia if rubbed on the skin with vinegar. Chinese physicians were known to use a mixture of jimson weed, marijuana, deadly nightshade, and mandrake placed into calamus leaves and burned over the operative or painful site to produce anesthesia. In the sixteenth century, Marco Aurelio Severino, an Italian anatomist and surgeon, advocated the use of cold to decrease pain, and this principle was frequently put to use by Napoleon's military surgeons. Other methods of inducing anesthesia locally included electrical current and superficial application of volatile liquids...."