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Daniel C. Moore, M.D.; Raymond F. Hain, M.D.; Arthur Ward, M.D.; Lloyd D. Bridenbaugh Jr., M.D.
JAMA. 1954;156(11):1050-1053. doi:10.1001/jama.1954.02950110012005.
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Physicians who inject nerve blocking agents, either to produce local anesthesia or to alleviate pain, are aware of the possible complications associated with these procedures. However, few seem to be cognizant of the potential significance of the relationship of the perineural spaces to the subarachnoid space and the spinal cord as the determining factor in the development of some of the more serious complications. This relationship was bluntly called to our attention by recent experiences after the use of Efocaine (a solution of 1% procaine, 0.25% procaine hydrochloride, and 5% butyl-p-aminobenzoate in a solvent composed of 2% polyethylene glycol 300, 78% propylene glycol, and water). It was originally advertised as a safe, long-acting (two to four weeks' duration), local anesthetic mixture unassociated with encapsulation, abscesses, foreign body reactions, tissue sloughs, or other such adverse effects encountered after the use of oil solvents.1 Early published reports seemed to


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