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Procaine and Local Anesthetic Toxicity: A Collaboration Between the Clinical and Basic Sciences

Jacob, James Seth MD; Kovac, Anthony L. MD

Regional Anesthesia and Pain Medicine: November/December 2017 - Volume 42 - Issue 6 - p 760–763
doi: 10.1097/AAP.0000000000000664
Regional Anesthesia and Acute Pain: History Article

In 1924, the Therapeutic Research Committee of the American Medical Association appointed a special committee to investigate deaths following the administration of local anesthetics. The Committee for the Study of Toxic Effects of Local Anesthetics found procaine, although a safer clinical alternative to cocaine, was capable of causing death when large doses were injected into tissues and advised that it should be used with caution. This article describes a collaboration beginning in 1928 between Dr John Lundy of the Mayo Clinic and Dr Robert Isenberger of the University of Kansas, which arose from a controversy surrounding systemic adverse reactions to procaine. Isenberger then traveled to the Mayo Clinic to conduct research on various procaine local and spinal anesthesia doses and sodium amytal's protective effect against procaine-induced toxicity. Lundy and Isenberger's work would add to the ongoing discovery of systemic reactions to local anesthetics.

From the Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.

Accepted for publication May 7, 2017.

Address correspondence to: James Seth Jacob, MD, Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1034, Kansas City, KS 66160 (e-mail:

The authors have no sources of funding to declare for this study.

The authors declare no conflict of interest.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.