Clinical Case Database / Category: Practical Procedure

Local anaesthetics and their uses in Emergency Medicine

Publication details

Christopher J. Blakeley FRCS FCEM
Foundation Years Journal, volume 1, issue 6, p.2 (123Doc Education, London, October 2007)


The concept of local anaesthesia was first introduced by the ophthalmologist Carl Koller in 1884 in conjunction with his work with Sigmund Freud on the systemic and local effects of cocaine. The concept of regional anaesthesia was introduced by William Halstead the following year. At the turn of the century Einhorn introduced the local anaesthetic procaine which remained the drug of choice until the introduction of lidocaine (lignocaine) in 1943. In 1973 bupivacaine, a longer acting local anaesthetic, was added to the growing list of available agents.

Local anaesthetics produce safe and effective analgesia in a wide variety of clinical settings from the simple insertion of a venous cannula to a femoral nerve block in the trauma patient.

The mode of action of local anaesthetics is to reduce membrane permeability to sodium. They act firstly upon small unmyelinated C fibres, thus pain and temperature are the first sensory modalities to be affected.

Doctors of all specialities must therefore be fully aware of the agents available, the techniques described and safety issues with regard to avoiding local anaesthetic toxicity.

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Christopher J. Blakeley FRCS FCEM (Corresponding author)

Accident & Emergency Consultant
Emergency Department
Mayday University Hospital
London Road


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2.  Hill R. Jr. Patterson J, Parker J, et al. Comparison of Transthecal Digital Block and Traditional Digital Block for Anesthesia of the Finger. Annals of Emergency Medicine 1994, 25(5), 604-607.

3.  Tondare A.S and Nadharni A.V. Femoral Nerve Block for Fractured Shaft of Femur. Canadian Journal of Anesthesia 1982; 29: 270-271.

4.  Kendall J.M, Allen P. Younge P. et al. Haematoma block or Bier’s block for Colles’ fracture reduction in the accident and emergency department - which is best? Journal of Accident and Emergency Medicine 1997; 14 (6): 352-356.


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