Morphine medical applications

Probably all commonly used local anesthetics have produced fatal accidents. These depend not only upon the absolute dose, but also on the rate of absorption, on idiosyncrasy, and on other conditions. The Local Anesthetic Committee of the American Medical Association has made recommendations that should minimize the accidents. The following are the most important. Procaine appears the safest of the more widely used local anesthetics and may be employed for subcutaneous and submucosal injections, but the concentration should not exceed 1%. Cocaine and butyn should not be injected under the skin or mucous membranes but restricted to surface application. The total quantity of cocaine should not exceed 0.06 to 0.1 g (1 to 1 1/2 grains). The patient should be recumbent if the operation permits. With nervous patients, it is advisable to inject morphine 15 min before the local anesthetic and to delay the start of the operation until 20 min after the injection of the local anesthetic. Urethral injections are especially dangerous, and should be avoided if there is trauma or stricture. 

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