How Does Novacaine Cause Numbness?

Would you please explain, in detail, how novacaine causes numbness. I have been unable to find information on the physiologic mechnism of action.


First, let me explain that there are two basic types of local anesthetic used in dentistry: 1) novacaine, which is an ester-type anesthetic; and 2) lidocaine, which is an amide-type anesthetic. Novacaine was discovered first, but due to allergic reactions, lidocaine and related anesthetics were developed in the 1940s. With the amide anesthetics, allergies are rare.

So how does novacaine work? Here are the steps involved in achieving local anesthesia as adapted from Malamed, Stanley F., Handbook of Local Anesthesia, 2nd Edition, C.V. Mosby Company (1986) p. 13:

  • Displacement of calcium ions from the nerve receptor site
  • Binding of local anesthetic molecule to this receptor site
  • Blockade of the sodium channel
  • Decrease in sodium conductance
  • Depression of rate of electrical depolarization
  • Failure to achieve threshold potential level
  • Lack of development of propagated action potential
  • Conduction blockade

These steps cause impulses that arrive in the blocked area to become stalled, thus preventing the "pain" impulses from reaching the brain.

The most commonly used local anesthetics are lidocaine or xylocaine. For most people, the anesthesia lasts about two hours. The duration of numbness depends on how long the anesthetic takes to diffuse out of the tissues.

by Kim Loos