We describe the case of a 29-year-old male with a history of cocaine use who was hospitalized for a traumatic femur fracture. After spinal anesthesia with buprenorfin and bupivacain, he had electrocardiographic evidence of inferior myocardial ischemia. He was treated successfully with intravenous nitroglycerin. We conclude that not only cocaine addicts, but also subjects with a past history of cocaine use, may be at risk for transient myocardial ischemia when anesthetized with local cocaine-like anesthetics.