The Use of Topical Cream Anesthetics in Office Procedures of the External Genitalia

The use of anesthesia during nineteenth century was extremely limited due to the hazards of the available anesthetics and the inability to successfully monitor the patient. This resulted in the majority of surgical procedures being performed without any anesthesia (Gordetsky et al, 2011). A revolutionary step in the history of anesthetics began in 1884, when Carl Koller, a scientist from Vienna, experimented with topical application of cocaine in the eye, achieving adequate surgical analgesia, without the potentially lethal side effects of inhalation anesthesia (Neilson, n.d.). The use of this natural alkaloid provided results superior to the contemporary general anesthesia and surgeons quickly appreciated the advantages of local anesthetics. Especially urologists embraced rapidly the promising local anesthetic and began experimenting with cocaine as a local agent for urological procedures, mainly by topical and intraurethral application (Gordetsky et al, 2011). It took a while for the initial enthusiasm to settle down as reports for side effects and addiction were bringing debate in the medical community. The need for less toxic drugs would lead to synthetic local drugs such as procaine; the discovery of the stable amide lignocaine in 1948 by Lofgren was an important milestone in the development of safe and effective local anesthetics.