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Cited 151 time in webofscience Cited 181 time in scopus
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Size and aggregation of corticosteroids used for epidural injections

Authors
Derby, RichardLee, Sang-HeonDate, Elaine S.Lee, Joo-HanLee, Chang-Hyung
Issue Date
Mar-2008
Publisher
OXFORD UNIV PRESS
Keywords
corticosteroid; size of particle; epidural injection; emblic infarction
Citation
PAIN MEDICINE, v.9, no.2, pp 227 - 234
Pages
8
Indexed
SCIE
SCOPUS
Journal Title
PAIN MEDICINE
Volume
9
Number
2
Start Page
227
End Page
234
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/17112
DOI
10.1111/j.1526-4637.2007.00341.x
ISSN
1526-2375
1526-4637
Abstract
Objective. The purpose of this study was to document particulate size in commonly used corticosteroid preparations. Inadvertent injection of particulate corticosteroids into a vertebral or foraminal artery can cause brain and spinal cord embolic infarcts and the size of the particles could be directly related to the chance that a clinically significant infarct would occur. One might assume that corticosteroids with particles significantly smaller than red blood cells might be safer. Design. The following four types of corticosteroid preparations were used in various solutions and evaluated under light microscopy: dexamethasone sodium phosphate injection, triamcinolone acetonide injectable suspension, betamethasone sodium phosphate and betamethasone acetate injectable suspension, and methylprednisolone acetate injectable suspension. Results. Dexamethasone sodium phosphate particle size was approximately 10 times smaller than red blood cells and the particles did not appear to aggregate; even mixed with 1% lidocaine HCl solution and with contrast dye, the size of the particles were unchanged. Triamcinolone acetonide and betamethasone sodium phosphate showed variable sizes; some particles were larger than red blood cells, and aggregation of particles was evident. Methylprednisolone acetate showed uniformity in size and the majority were smaller than red blood cells which were not aggregated, but the particles were densely packed. Conclusions. Compared with the particulate steroid solutions, dexamethasone sodium phosphate had particles that were significantly smaller than red blood cells, had the least tendency to aggregation, and had the lowest density. These characteristics should significantly reduce the risk of embolic infarcts or prevent them from occurring after intra-arterial injection. Until shown otherwise in clinical studies, interventionalists might consider using dexamethasone or another corticosteroid preparation with similar high solubility and negligible particle size when performing epidural injections.
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2. Clinical Science > Department of Pathology > 1. Journal Articles
2. Clinical Science > Department of Physical Medicine and Rehabilitation > 1. Journal Articles

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Lee, Sang Heon
Anam Hospital (Department of Physical Medicine and Rehabilitation, Anam Hospital)
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