{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:57:05Z","timestamp":1790510225270,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,6,15]],"date-time":"2015-06-15T00:00:00Z","timestamp":1434326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Targeted spinal steroid injections are effective in reducing back pain in selected patient populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non\u2010particulate steroid agents for all spinal injections to reduce the risk of neurovascular embolic adverse events. Many injections have used a combination of local anaesthetic agent with the steroid. At our institutions, we have recently observed interactions between ropivacaine and dexamethasone 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 steroid combinations to determine if such precipitation effects are more widespread.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The commonly used local anaesthetics (lignocaine, bupivacaine, ropivacaine) and the non\u2010particulate steroid dexamethasone sodium phosphate combinations were evaluated macroscopically, microscopically, and <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of ropivacaine with sodium bicarbonate solution was also evaluated. Particulate size of the particulate steroid agent betamethasone acetate was evaluated as a comparison.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All mixtures of ropivacaine and the non\u2010particulate dexamethasone sodium phosphate assessed demonstrated a <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\u2010dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of dexamethasone and lignocaine or bupivacaine. Contamination of ropivacaine with residual sodium bicarbonate in a drawing up needle following air clearing had a precipitation effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We describe the effect of crystallisation with the combination of ropivacaine and the non\u2010particulate steroid, dexamethasone sodium phosphate, a mixture that has been used in the literature for targeted pain injections. As this may be considered a non\u2010particulate steroid\/anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate steroid agents. This is due to the elevated <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> of dexamethasone and the incompatibility of ropivacaine with alkaline solutions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1754-9485.12333","type":"journal-article","created":{"date-parts":[[2015,6,15]],"date-time":"2015-06-15T10:18:52Z","timestamp":1434363532000},"page":"571-577","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections"],"prefix":"10.1111","volume":"59","author":[{"given":"Trevor William","family":"Watkins","sequence":"first","affiliation":[{"name":"Department of Medical Imaging Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Dupre","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Nambour General Hospital  Nambour Queensland Australia"},{"name":"University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Richard","family":"Coucher","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,15]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"DutheyB.Update on 2004 Background Paper BP 6.24 Low Back pain. 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