The clinical use of cocaine

Cocaine is an extremely useful drug for various otolaryngologic procedures, and as an anesthetic it is unrivaled for vasoconstriction and decongestion. Its use should not be restricted any more than any other controlled drug. In the majority of procedures 200 to 300 mg. of cocaine is sufficient to obtain adequate anesthesia, decongestion, and vasoconstriction. In cases in which this amount may be less than adequate, injections of lidocaine with epinephrine can be used to supplement the anesthetic action of cocaine. It is difficult to imagine a case requiring 1000 mg. of cocaine as some physicians have reported in the past. To prevent mistaken injections of cocaine solutions, we recommend that they be colored by the pharmacy. To prevent overdosing we recommend starting with a known amount and not exceeding this total dose. We have chosen 200 to 300 mg. as our total dose for most adult procedures. Some pharmacies prepare 250 mg. of cocaine base in saline for those who prefer a cocaine "slush"; this, too, would be acceptable.