Compunded Betamethasone SOLUTION

thepainguy said:

Has anyone used a betamethasone solution for cervical injections? I heard about it a pain meeting in Texas a couple of weeks ago. Less complications if you have vascular uptake since there is no particulate matter in the drug.

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When you refer to betamethasone "solution", are you refering to compounded aqueous betamethasone? and in addition to their lack of complications, what was the efficacy?

I ask becasue I had opportunity to speak to Paul Dreyfuss on this topic, and he was using dexamethasone. He had looked at his numbers and found that is eficacacy had been reduced by about 10% (60 down to 50) but that the risk of using particulate steroid was too great for a mere 10% bump in efficacy. (Please note this conversation happened last year, so Dr. Dreufuss may have modified this since I last had opportunity to speak with him)

lobelsteve said:

It is much less particulate as in much smaller particulates.

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Per Tiso (Spine J. 2004 Jul-Aug;4(4):468-74) just cause a solution looks less particulate doesnt mean it is less particulate.

1. Particulates have not been demonstrated to be the cause of transforaminal disasters. It is sheer speculation. Other mechanisms may be placement of a needle directly through the carotid and vertebral arteries since the "foraminal view" places these structures directly in the line of fire, overpressurization of the lateral epidural space and subsequently the cord due to excessive volume used or injection speed, injection into the venous intraforaminal plexus, etc.
2. The injection of any solution rather than particulate containing suspension cannot last have a local effect more than a few hours or at most, a day. The vascular plexus is extensive and washout of solutions vs suspensions is rapid and complete. If you don't think this is the case, simply inject omnipaque and wait 10 minutes, then re-expose the patient to fluoroscopy...you will be hard pressed to find any omnipaque. Therefore, if a person states they are receiving significant long term effect using a solution injected into the neuroforamina, it must be due to a systemic effect, and therefore the patients would do just as well with an intramuscular injection of dexamethasone.
3. Many compounding pharmacies in general do not use testing to assure each lot is devoid of bacterial or fungal activity. If they do not, then they may add benzyl alcohol to the solution which is a known neurotoxin.

I remember reading about Celestone in a pharmaceutical catalog, and then proceeded to look it up. I figured id use it in the lumbar as well as cervical areas. I found a few papers, the one i remember most noted decreased efficacy by a substantial amount. After awhile, i thought the same thing Algos mentioned.......plus i think my fellowship professors wouldnt have been using Kenalog if it wasnt safe. Purely anecdotal.

T