We performed a double-blind, randomized, prospective study to determine the local anesthetic that provided the best analgesia for insertion, of an 18-gauge intravenous (IV) catheter and to determine whether al-kalinization of lidocaine decreases the pain of intradermal injection. There were 280 healthy adult patients assigned randomly to seven different groups: benzyl alcohol 0.9% in normal saline, 2-chloroprocaine 3%, lidocaine 1%, lidocaine 1% with preservative, alkalinized lidocaine 1% with preservative, normal saline, and a control group that received IV catheter placement without previous drug injection. A 10-cm visual analog pain scale (VAPS) was used to obtain pain scores after pre-IV drug injection and after IV catheter insertion. Benzyl alcohol in normal saline (0.61 ± 0.11) and alkalinized lidocaine (0.69 ± 0.10) had the lowest mean pain scores for drug injection and these were significantly different from other drugs (P < 0.05). Alkalinized lidocaine (0.7 ± 0.18) had the lowest mean pain score for IV catheter insertion with nothing (no previous drug injected) (3.47 ± 0.38) and normal saline (3.97 ± 0.18) had the highest mean pain scores (P < 0.05). We conclude that alkalinized lidocaine decreased the pain associated with its injection. Alkalinized lidocaine was the best local anesthetic for IV catheter placement. Benzyl alcohol in normal saline was also effective.