Sensory-selective local anesthesia has long been a key goal in local anesthetic development. For example, it allows women to be painfree during labor without compromising their ability to push. Here we show that prolonged sensory-selective nerve block can be produced by specific concentrations of surfactants-such as are used to enhance drug flux across skin-in combination with QX-314, a lidocaine derivative that has relative difficulty penetrating nerves. For example, injection of 25 mM QX-314 in 30 mM octyltrimethylammonium bromide (OTAB) lasted up to 7 h. Sensory selectivity was imparted to varying degrees by cationic, neutral, and anionic surfactants, and also was achieved with another lidocaine derivative, QX-222. Simultaneous injection of OTAB at a s.c. injection site remote from the sciatic nerve did not result in prolonged sensory-specific nerve blockade from QX-314, suggesting that the observed effect is due to a local interaction between the surfactant and the lidocaine derivative, not a systemic effect.analgesia | quaternary lidocaine derivative | sensory | surfactant | local anesthetics P eripheral nerves contain separate populations of axons that serve specific functions, including sensation and movement. The development of local anesthetics that would block sensory nerves without impairing motor nerve function has long been a key goal. One notable example of its potential applicability is in labor analgesia; such blockade would allow the parturient to push effectively without feeling pain. There are recent reports of local anesthetic formulations with varying degrees of sensory selectivity, albeit of relatively brief duration. One report described a combination of QX-314 with the vanilloid receptor agonist capsaicin (1). QX-314, QX-222, and similar compounds are quaternary lidocaine derivatives with obligate positive charges (2, 3) that thus have greater difficulty reaching their targets on the inner surface of the cell membranes than do their uncharged counterparts. According to that report, capsaicin opens the TRPV1 channel on sensory nerves alone, allowing QX-314 to enter sensory cells only. Another report described an increase in the relative proportion of sensory block from a combination of lidocaine (the nonquaternary parent molecule of QX-314) with capsaicin (4). Lidocaine itself can open the TRPV1 channel and has been shown to produce sensory-predominant nerve blockade in the presence of QX-314 (5).The action of local anesthetics is curtailed by obstacles to their penetration to nerves, as evidenced by the large difference in concentrations required to achieve nerve blockade in isolated nerves and in vivo (6-10). We have hypothesized that chemical permeation enhancers (CPEs), such as those used to enhance transdermal drug delivery, might increase drug flux across those barriers, resulting in longer-duration nerve blocks. Recently, we demonstrated that a wide range of surfactant CPEs dramatically increased the duration of rat sciatic nerve blockade from tetrodotoxin, but had little or no effe...