Non-Particulate Steroids

Purpose: Particulate steroids used in epidural steroid injections have been suspected as a cause of post-procedural embolic events. Some particulate steroids have been suspended only when the transforaminal approach is used for an epidural block of the spine. In contrast, non-particulate steroids ar...

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Bibliographic Details
Published in:Journal of pain research 2021-05, Vol.14, p.1495
Main Authors: Nahm, Francis Sahngun, Lee, Ho-Jin, Kim, Dong-Hyun, Choi, Eun Joo, Han, Woong Ki, Lee, Pyung-Bok, Kang, Imhong
Format: Article
Language:English
Subjects:
Air pollution
Betamethasone
Bupivacaine
Dexamethasone
Drugs and athletes
Fluorescence microscopy
Lidocaine
Phosphates
Steroids
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Summary:Purpose: Particulate steroids used in epidural steroid injections have been suspected as a cause of post-procedural embolic events. Some particulate steroids have been suspended only when the transforaminal approach is used for an epidural block of the spine. In contrast, non-particulate steroids are generally accepted for safety during epidural steroid injections. However, the safety of using a mixture of non-particulate steroids and local anesthetics is unknown. This study analyzed whether mixtures of commonly used non-particulate steroids and local anesthetics form crystals in solution. Methods: We mixed non-particulate steroids (betamethasone sodium phosphate, dexamethasone sodium phosphate, and dexamethasone palmitate) and local anesthetics (ropivacaine, levobupivacaine, bupivacaine, and lidocaine) at different ratios. We used fluorescence microscopy to observe whether crystals formed in mixed solutions; we also measured the pH of each steroid, local anesthetic, and the mixtures. Results: Ropivacaine or levobupivacaine and betamethasone sodium phosphate produced large crystals (>50 [micro]m). Ropivacaine or levobupivacaine and dexamethasone sodium phosphate produced small crystals (
ISSN:1178-7090
1178-7090