@entity1342 and @entity619 : a potentially dangerous combination for therapeutic XXXX injections.

@entity1 @entity21025 @entity4388 @entity1342 @entity615 @entity619 @entity3303 @entity1341 @entity43756 @entity158 @entity10457 @entity531 @entity479
INTRODUCTION: Targeted spinal @entity479 injections are effective in @entity615 in selected @entity1 populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non-particulate @entity479 agents for all spinal injections to reduce the risk of @entity531 adverse events. Many injections have used a combination of local anaesthetic agent with the @entity479 . At our institutions, we have recently observed interactions between @entity1342 and @entity619 combinations ascribed to the incompatibility of the former with alkaline solutions, resulting in rapid crystallisation. This study has further investigated the combinations of commonly used local anaesthetic and @entity479 combinations to determine if such precipitation effects are more widespread. METHODS: The commonly used local anaesthetics ( @entity3303 , @entity1341 , @entity1342 ) and the non-particulate @entity479 @entity619 @entity10457 combinations were evaluated macroscopically, microscopically, and pH values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of @entity1342 with @entity4388 solution was also evaluated. Particulate size of the particulate @entity479 agent @entity43756 was evaluated as a comparison. RESULTS: All mixtures of @entity1342 and the non-particulate @entity619 @entity10457 assessed demonstrated a pH-dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of @entity619 and @entity3303 or @entity1341 . Contamination of @entity1342 with residual @entity4388 in a drawing up needle following air clearing had a precipitation effect. CONCLUSION: We describe the effect of crystallisation with the combination of @entity1342 and the non-particulate @entity479 , @entity21025 , a mixture that has been used in the literature for targeted @entity158 injections. As this may be considered a non-particulate @entity479 /anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate @entity479 agents. This is due to the elevated pH of @entity619 and the incompatibility of @entity1342 with alkaline solutions.
