Clinical use of cocaine. A review of the risks and benefits

Following the isolation of cocaine from the extract of coca leaves in the late 1700s by Albert Neiman, the local anaesthetic properties of the drug have been evaluated. The anaesthetic effect of cocaine is believed to be the result of reversible blockade of nervous impulse conduction by the prevention of sodium ion movement within the cell membrane. The many undesired effects, however, are the result of adrenergic stimulation by means of prevention of noradrenaline (norepinephrine) uptake. The clinical use of cocaine in the modern era is associated primarily with surgical procedures involving the manipulation of mucous membranes, particularly those of the upper respiratory tract. Recently, based on problems with the potential for illicit use and adverse effects, alternative regimens have been investigated. In some settings these have been superior to cocaine. Further studies comparing various anaesthetic regimens are warranted.