Superiority of Pentazocine in Myocardial Infarction

To the Editor.—  Although all the evidence in his review points in the opposite direction, Dr. Alderman concludes that "morphine remains the analgesic of choice during the acute phase of myocardial infarction" (229:1646, 1974). He also overlooks the advantage that pentazocine is not listed on the Controlled Substances Act because it has not been found to have potential for abuse to date.A source of amazement to the anesthesiologist is the continuing preference of morphine by cardiologists at this time when comparatively ultrashort-acting narcotics that do not release significant amounts of histamine are available. There is no question of the greater safety of fentanyl citrate (Sublimaze) among anesthesiologists. Thus, the originator of neuroleptanalgesia, De Castro, routinely administers 3 mg of fentanyl as part of the symptomatic treatment of shock,¹ which is the equianalgesic dose of at least 300 mg of morphine. However, as anesthesiologists who provide analgesia and anesthesia to