The fascinating history of local anesthetics (LAs) began in South America with the herbal and traditional use of cocaine leaves by the indigenous peoples of Peru and Bolivia, the sacred plant of the Incas Erythroxylum coca. The use for anesthetic purposes dates back to 1884. Since then, the evolution of LAs has been closely related to research motivated by its efficacy and safety versus toxicity. According to their chemical structure, these drugs are classified into two main groups: esters and amino amides; however, there are three LAs with different characteristics: articaine, sameridine, and centbucridine. The pharmacological and toxic mode of action is primarily in the voltage-dependent sodium channels located in the cell membrane, which clinically produces analgesia, anesthesia, seizures, arrhythmias, and cardiac arrest. The quality of anesthesia and analgesia depends on the type of LA, dose, and application technique, while the deleterious effects are secondary to its plasma concentration. Nonanesthetic properties of LAs such as their antimicrobial, antineoplastic, antiarrhythmics, antitussive, and antiasthmatics effects have been described and are briefly reviewed.

Plastic surgery is currently more popular and available with increasing frequency throughout the world. Its advances are related to progress in anesthesiology. Nowadays, it is possible to operate patients with pathologies that previously did not allow this type of surgery. The developments in perioperative monitoring, pharmacology, prevention of complications, and the wide communication between patients and physicians, as well as the development of surgical units that facilitate a prompt programming and reduce the total costs, have resulted in a logarithmic growth of plastic and reconstructive surgery procedures. Local, regional, or general anesthesia, anesthetic monitoring, or conscious sedation is used routinely, allowing to manage patients as ambulatory or short stay. Deep vein thrombosis and pulmonary embolism remain the most frequent complications, followed by postoperative pain, nausea, and vomiting.