SKIN 
 

May 2018     Volume 2 Issue 3 
 

Copyright 2018 The National Society for Cutaneous Medicine 205 

Compelling Comments 
 

 

Cocaine and the Local Anesthetic 
 
Tyler Marion BS MBA

a
,
 
Jake Alan Gibbons BSA

a
 

 

a
The University of Texas Medical Branch, Galveston, TX

 
 

 

 
 
 
The first use of local anesthetics dates back 
to the 16th century when Bernabe Cobo, a 
Spanish missionary, noted that toothaches 
could be alleviated by chewing coca leaves.

1
 

However, the active component remained a 
mystery until 1860 when German chemist, 
Albert Niemann, isolated and termed the 
component ‘cocaine’.

1
 The discovery of 

cocaine sparked great interest within the 
medical community. Amongst those 
interested was founder of psychoanalysis, 
Sigmund Freud. Freud experimented with 
cocaine, erroneously reporting that cocaine 
produced no compulsive desire to reuse the 
substance.

2
 During this same time period, 

Dr. Carl Koller, a Viennese ophthalmologist 
and acquaintance of Freud, pioneered the 
use of cocaine as an anesthetic through his 
experiments focused on the cornea of dogs 
and guinea pigs.

1
 Cocaine was used for a 

nerve block for the first time in 1884 by 
William Halsted, one of the founders of John 
Hopkins School of Medicine.

2
 

 
Advancements were made using cocaine as 
an anesthetic, including the first spinal 
anesthesia performed by James Corning.

2
 

However, the toxicities and addictive 
potential of cocaine were identified, leading 
to decreased use as an anesthetic. 
Researchers were prompted to experiment 
with other agents. An early breakthrough 
came in 1905, when Alfred Einhorn, a 

German chemist, synthesized procaine. A 
derivative of paraaminobenzoic acid, 
procaine gained popularity due to its wide 
safety margin, but carried the risk of allergic 
reactions in patients.

3
 In 1943, Nils Löfgren 

and Bengt Lundqvist from Stockholm 
University developed lidocaine, a long-acting 
anesthetic agent without the propensity of 
allergic reactions.

1
 Lidocaine gained 

popularity amongst clinicians and became 
the ubiquitous drug that it is today in 
dermatology. Dermatologists commonly 
administer intradermal injections of lidocaine 
for skin biopsies, lesion excisions, and soft 
tissue augmentation. Although cocaine is no 
longer used for numbing effects, it paved the 
way for the development of local anesthetics 
still used today. 

 
 
Conflict of Interest Disclosures: None 

 
Funding: None 

 
Corresponding Author: 

Tyler Marion, BS, MBA 
301 University Blvd, Galveston, TX 77555 
817-501-9357 
tmarion9@gmail.com 
 
 
 

 
 



SKIN 
 

May 2018     Volume 2 Issue 3 
 

Copyright 2018 The National Society for Cutaneous Medicine 206 

References: 

  
1. Walsh A, Walsh S. Local anaesthesia 

and the dermatologist. Clin Exp 
Dermatol. 2011;36(4):337-343. 

 
2. Redman M. Cocaine: What is the crack? 

A brief history of the use of cocaine as 
an anesthetic. Reg Anesth Pain Med. 
2011;1(2). 
 

3. Grekin RC, Auletta MJ. Local anesthesia 
in dermatologic surgery. J Am Acad 
Dermatol. 1988;19(4):599-596.