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Local anaesthetic substitutes for cocaine

The early twentieth century saw the production of a large number of local anaesthetic drugs as alternatives to cocaine. The paper under consideration describes a study which compared 11 of those drugs with cocaine, using criteria put forward earlier by Braun. The therapeutic ratio, water solubility, chemical stability in solution, potency, systemic toxicity, local tissue toxicity, and compatibility with adrenalin of each drug were assessed and compared in wide-ranging bench and animal studies. Comparisons of potency would also seem to have been performed in man. The overall conclusion was that procaine, which became the standard agent until lidocaine was introduced, was clearly superior. However, the paper is virtually unknown, in spite of describing what would appear to have been the definitive study of the period.