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PubMedDate not supplied

Effect of positioning on discomfort from intramuscular injections in the dorsogluteal site.

An intramuscular injection into a relaxed muscle is believed to result in less discomfort than an injection into a contracted muscle. When the femur is internally rotated, the gluteus maximus muscle is relaxed. The hypothesis that a dorsogluteal injection with the femur internally rotated will cause less discomfort than when the femur is externally rotated was tested in 44 surgical patients who received two injections of preoperative medication. Each patient received an injection of a narcotic medication and one of diazepam. All possible combinations of the factors--position (internal and external rotation), order of injection (first or second injection), and medication (narcotic or diazepam)--were determined, and patients were randomly assigned to one of these conditions. Patients rated their perceived discomfort after each injection on a five-point scale. The hypothesis was supported by discomfort ratings from injections of both types of medications, although diazepam injections caused significantly more discomfort than injections of narcotics. Older patients tended to report less discomfort from diazepam injections than younger patients. Sex, order of injection, and nurse administering the injection did not significantly influence discomfort ratings.

Adult↗

PubMed1977

Effects of intramuscular injections of selenium and vitamin E on selenium-vitamin E deficiency in young pigs.

Effects of intramuscular injections of selenium and vitamin E on lesions in pigs with selenium-vitamin E deficiency syndrome were determined in 2 factorial experiments, using a total 69 pigs. The pigs were fed a selenium-vitamin E deficient, 22.3% protein ration, supplemented with methionine, minerals, and vitamins. Weekly intramuscular injections of isotonic saline solution, vitamin E, selenium, or vitamin E and selenium were given to the respective treatment groups. Selenium-vitamin E deficiency lesions occurred only in pigs that were given saline injections. Weekly intramuscular injections of either selenium (as selenous acid buffered to pH (7.3) at the rate of 0.05 mg/kg of body weight or vitamin E at the rate of 20 IU/kg of body weight or the combination of selenium and vitamin E prevented cardiac and skeletal myodegeneration, hepatic necrosis, and death. Significant increases of serum aspartate aminotransferase activity values were noted in pigs with liver, heart, or skeletal muscle lesions, but these increases were not correlated with the extent of the lesions. Vascular lesions, epicardial and endocardial hemorrhages, and yellow discoloration of body fat were not features of this experimentally induced disease. These lesions may be related to factors other than the deficiency of selenium, vitamin E, or selenium and vitamin E in rations previously used in reported studies.

Animals↗

PubMed1977

Intramuscular injections and bioavailability.

Bioavailability of drugs following intramuscular injection is reviewed, with particular emphasis on diazepam, chlordiazepoxide, phenytoin, digoxin and lidocaine. Clinical experience with these drugs has shown that i.m. absorption may be slow, erratic or incomplete. Factors which play a role in the bioavailability of i.m. medications include the water solubility of the drug, dispersion of the injected solution and blood flow at the muscle site. For many drugs, intravenous injection is the parenteral route of choice, and oral administration may be more efficacious than i.m. injection.

Absorption↗

PubMed1977

[Intramuscular injections and activity of serum creatine phosphokinase. Histopathological study in animal experiments].

In healthy Labrador dogs a single intramuscular injection of benzoctamin, diazepam and pethidin leads to a distinct increase in serum-creatine-phosphokinase (SCK) activity, whilst a single intramuscular injection of physiologic saline has no effect whatsoever. Intravenous injection of an identical dose of the above-mentioned drugs leaves SCK activity unchanged. Muscle specimens of the injection site, excised 5 days after intramuscular injection of the same drugs, display muscle cell necrosis, macrophage proliferation and reparative changes. The impressive histological alterations point to the striated muscle cell as a probable source of the increase in SCK activity (MM fraction).

Animals↗

PubMed1975

[A new technique for intramuscular injections (author's transl)].

Among the methods for intramuscular injection, Hochstetters technique into the gluteus medius muscle is anatomically sound, but there are a few practical defects which make it difficult to perform. The method we describe has been tested and is simpler. Anatomical orientation is easier, vessels and nerves are not endangered, asepsis is better guaranteed, and the injection can be given with the patient in any position, even lying down. Instead of Hochstetters method of injecting into the vastus lateralis muscle, in which three connecting lines must be drawn mentally, we use our simple method: the injection is given in the middle third of the thigh, dorsal to a line joining the anterior superior iliac spine and the lateral border of the patella.

Adolescent↗

PubMed1992

Pediatric intramuscular injections: do you know the procedure and complications?

The practice of outpatient intramuscular antibiotic therapy for infants and children at risk for serious bacterial infections is an attractive alternative to hospitalization. The use of this alternative is likely to increase. Pediatric emergency physicians and pediatric residents at our institution were surveyed to determine their knowledge of intramuscular injection techniques. The dorsogluteal site is contraindicated in infants and children, but it was selected for 14 (21%) of the patients presented in the survey. One-inch needles are recommended for children 0 to 24 months of age, but 1 1/2-inch needles were preferred for 13 (30%) of these younger children. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. To avoid these complications, guidelines for pediatric intramuscular injections are presented.

Ambulatory Care↗

PubMed1977

Quadriceps contracture as a result of multiple intramuscular injection.

Quadriceps contracture in children can result from multiple intramuscular injections. We describe here seven patients with this complication. These patients were unable to completely flex the involved knee. At surgery, extensive fibrosis of the quadriceps muscle was found. Lengthening of the scar and contracted muscle and tendon restored a good deal of flexion. If long-term antibiotic treatment is anticipated, the intravenous route should be employed if possible.

Child↗

PubMed1976

The effect on serum enzymes of intramuscular injections of digoxin, bumetanide, pentazocine and isotonic sodium chloride.

Intramuscular injections of digoxin, bumetanide, pentazocine or isotonic sodium chloride have been given to 39 patients. We followed the serum concentrations of creatine kinase (CK), aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH) and LDH isoenzymes for 4 days. Ten patients receiving 500 mug digoxin showed a significant rise in CK, which lasted for 48 hours, and 6 of them had CK values exceeding the upper normal limit. Pentazocine in a dose of 30 mg given to 9 patients caused a significant rise in CK and LDH isoenzyme 1, but in no case did the level exceed the upper normal limit. No rise in ASAT or total LDH was found after digoxin and pentazocine injections. No changes in enzymes were discovered after bumetanide or isotonic sodium chloride. In the diagnostic evaluation of acute myocardial infarction, a moderate rise in CK must be assessed with caution when the patients have received i.m. injections of drugs with osmolarity and pH outside the physiological limits.

Aspartate Aminotransferases↗

PubMed1975

Midtrimester abortion induced by serial intramuscular injections of 15(S)-15-methyl-prostaglandin E2 methyl ester.

Midtrimester abortion was successfully induced in 29 of 30 patients with serial intramuscular injections of 15(S)-15-methyl-prostaglandin E2 methyl ester (15-ME-PGE2). The mean abortion time was 9.52 hours; parous patients aborted somewhat faster (mean, 8.76 hours) than nulliparous patients (mean, 10.47 hours). Eight patients were monitored throughout the abortion procedure and uterine activity was calculated and analyzed. Uterine response to a single injection of 5 mug 15-ME-PGE2 was characterized by the rapid appearance of low-amplitude, high-frequency contractions accompanied by a rise in intrauterine baseline tonus. Uterine activity rose to a mean of 500 Montevideo Units within 40 minutes of the initial intramuscular injection of 15-ME-PGE2. The most frequently encountered side effect of intramuscular injections of 15-ME-PGE2 was temperature elevation of 2 degrees F. or higher, which occurred in 29 of 30 patients. Five patients complained of shaking and chills but only five patients had any gastrointestinal side effects. From this study it appeared that on a weight-for-weight basis 15-ME-PGE2 is at least 20 times more potent than 15-ME-PGE2alpha and 1,000 time more potent than the naturally occurring PGE2.

Abortifacient Agents↗

PubMed1976

Termination of midtrimester pregnancy by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha.

Midtrimester abortion was successfully induced in 117 of 120 patients with serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha (15-me-PGF2alpha). The mean abortion time was 14.12 hours, and parous patients aborted in a mean of 12.85 hours-significantly faster than nulliparous patients who aborted in a mean of 15.24 hours. Ninety-four per cent of the 117 successfully induced abortions occurred in less than 24 hours and 46 per cent in less than 12 hours. Uterine activity was monitored and analyzed in nine patients. Uterine response to a single intramuscular injection of 100 mug of 15-me-PGF2alpha was characterized by the appearance of low-amplitude, high frequency contractions and a rapid increase in baseline intrauterine tonus. A high level of uterine activity, 900 Montevideo Units, was observed within 30 minutes of the first intramuscular injection of 15-me-PGF2alpha. This activity was not maintained and decreased by approximately 30 per cent at the time of the second injection at 1 hour. It was not until 6 hours of 15-me-PGF2alpha therapy that activity stabilized at approximately 500 Montevideo Units. Even though all patients were premedicated with antiemetic and antidiarrhea agents, 68 of 120 patients experienced gastrointestinal side effects related to the 15-me-PGF2alpha administration. Vomiting was the most prevalent side effect, occuring in 65 patients, but the episodes were not severe, were well tolerated by the patients and did not necessitate the termination of prostaglandin administration in any of the patients. In this study abortion was successfully induced between weeks 9 to 27 of gestation. It was observed that patients with gestations of 16 weeks or less aborted significantly faster than patients with gestations of 17 weeks or more, which indicates that this method is highly effective in the induction of abortion within the "gray zone", 12 to 16 weeks of gestation.

Abortifacient Agents↗

PubMed1978

A comparative study of serum creatine phosphokinase (CPK) activity in rabbits, pigs and humans after intramuscular injection of local damaging drugs.

Serum creatine phosphokinase (CPK) activity has been determined before and after intramuscular injection of lidocaine, diazepam or saline in humans and lidocaine, diazepam, digoxin and saline in pigs and rabbits. Two ml volum of each of the drugs was given to humans as well as to the experimental animals. No changes in CPK activity were found after saline in humans or rabbits but a minor increase was demonstrated in pigs. A marked increase of CPK activity was demonstrated after lidocaine or diazepam in humans and after lidocaine, diazepam or digoxin in pigs and rabbits. Post mortem examination of the injection sites in the animals revealed extensive muscle tissue necrosis after lidocaine, diazepam and digoxin. No damage of the tissue was found after saline. CPK activity was also determined in rabbits receiving 2 ml of dilutions of diazepam in saline. The injection sites were examined post mortem. The CPK activity was increased in animals receiving 1:2 and 1:8 dilutions while a 1:20 dilution did not give rise to changes in the enzyme activity. The necrotic area diminished when diazepam was diluted and no pathological changes were found at the injection sites after the 1:20 dilution. Measuring the CPK activity in rabbits after an intramuscular injection seems to be a sensitive method for the determination of local toxicity.

Animals↗

PubMed1975

[The behaviour of creatine phosphokinase in serum after the intramuscular injection of a Tetracyclin preparation (author's transl)].

The single intramuscular injection of 275 mg Rolitetracyclin (Reverin) led to a rise in serum creatine phosphokinase in 11 out of 20 heart healthy patients, 7 cases with values over 100 mU/ml. In sane cases the initial values had still not been reached 72 hours after injection. With Rolitetracyclin given intravenously the creatine phosphokinase values do not alter, as with an isotonic Na-Cl solution given intramuscularly. A rise in the serum creatine phosphokinase was seen in 2 out of 6 cases after an intramuscular injection of Oxytetracyclin (Terramycin -Depot). One is not dealing with a reaction which is typical only to Rolitetracyclin. The cause is thought to be the setting free of enzymes through the musclelesions. The results underline the sensitivity of and problems involved with creatine phosphokinase in the diagnosis of heart-infarction.

Adult↗

PubMed1979

The loss of creatine phosphokinase (CK) from intramuscular injection sites in rabbits. A predictive tool for local toxicity.

The CK activity was measured in muscle tissue taken from the injected area (dorsal longissimus muscle) and the contralateral side of the injection site 72 hours after intramuscular injection into rabbits of 1 ml of different dilutions of propylene glycol or glycerol formal in distilled water or 0.9% saline. The total loss of CK activity from the injection site was calculated as the difference between the CK concentration in the normal muscle tissue and that of the injection site from the same animal. From the results the arbitrary amount of muscle tissue depleted of CK activity was further calculated and compared with the severity of the gross pathological findings. A large necrotic area at the injection site was present in all samples with more than 1 g of muscle tissue depleted of CK activity. Minor and probably acceptable pathological changes were found in samples with less than 1 g of muscle tissue depleted of CK activity. The local damaging effect of drug preparations for intramuscular use can thus be evaluated from the calculated amount of muscle tissue depleted of CK activity.

Animals↗

PubMed1979

Immunization of mice with gamma-irradiated intramuscularly injected schistosomula of Schistosoma mansoni.

The parameters involved in the induction of resistance against Schistosoma mansoni by injection of irradiated, artificially transformed schistosomula were studied in mice. Single intramuscular injections of 500 schistosomula exposed to radiation doses in the range 2.3 to 160 krad. resulted in significant protection (in the range 20 to 50% as assessed by reduced worm burdens) against a challenge infection administered at intervals from 3 to 24 weeks post-vaccination. However, schistosomula irradiated with 20 krad. consistently resulted in better protection than those exposed to either higher or lower radiation doses despite the persistence of stunted adults from the infections irradiated with 2.3 krad. Vaccination with 40 krad. schistosomula resulted in significant protection in terms of reduced worm and tissue egg burdens and increased survival following lethal challenge. Varying the number of irradiated schistosomula, the frequency and route of their administration, the site of challenge and the strain of host all failed to enhance the level of resistance. However, percutaneously applied, irradiated cercariae were found to be more effective in stimulating resistance (60%) than intramuscularly injected, irradiated schistosomula (40%).

Animals↗

PubMed1992

Tissue reaction after intramuscular injection of liposomes in mice.

Liposomes are effective carrier systems for prolonged drug release. As all other drug formulations for parenteral use, the safety of liposomal formulations should be established before clinical application. In this study, some safety aspects of intramuscularly injected (single dose) "gel-state" type liposomes and the ability of liposome encapsulation to diminish irritating effects of intramuscularly applied drugs were studied by histopathological analysis over a period of 14 days in mice. Injection of saline solution showed no tissue reaction at the injection site. Intramuscular injection of liposomes alone showed an infiltrative reaction consisting of a population of macrophages. Within this population fat cells were present. In time, the population of macrophages present at the injection site was largely replaced by loose connective tissue. Novaminsulfon (NS) injected intramuscularly in "free" form is a strongly irritating drug, causing hemorrhage, cell necrosis, inflammatory reactions and eventually fibrosis. However, NS being encapsulated in liposomes was hardly more irritating than liposomes alone. The same was true for liposome-encapsulated chloroquine and free chloroquine. When sustained-release of a drug is therapeutically desirable, the parenteral application of a liposome-encapsulated formulation can be considered for drugs, in particular for those drugs causing tissue injury at the injection site.

Animals↗

PubMed1977

Local skin necroses after intramuscular injection -Experimental animal studies-.

The pathogenesis of local skin necroses after intramuscular injection of various drugs such as phenylbutazone (Embolia cutis medicamentosa, Nicolau's syndrome) is not clear. In an attempt to simulate this clinical feature experiments were performed on the rabbit ear lobe. A 20% phenylbutazone solution was injected paraarterial, intraarterial and paraarterial after perforation of the vessel. The drug produced a violent inflammation with all kinds of application. The local inflammation induced by paraarterial injection resulted in a fine scarring. Both other kinds of application produced necroses or even perforations. The histological examinations in these cases revealed massive destructions of the inner arterial wall. In control-experiments necroses or perforations were nerve observed. From these data the following conclusions on the etiology of Nicolau's syndrome can be drawn: Phenylbutazone injected into the vascular or perivascular tissue causes an obligatory inflammation. After lesion of an artery complete destruction of the vessel followed by necrosis of the skin may occur. It seems obvious that this secondary effect can not completely be avoided.

Animals↗

PubMed1977

Serum medroxyprogesterone acetate (MPA) concentrations and ovarian function following intramuscular injection of depo-MPA.

A sensitive radioimmunoassay measuring serum medroxyprogesterone acetate (MPA) has been developed in order to measure and correlate serum MPA concentrations and ovarian function in women following im administration of deop-MPA (DMPA), employing goat anti-MPA-3-(O-carboxymethyl) oxime-bovine serum albumin and MPA-3-(O-carboxymethyl) imino-125I-iodohistamine. In the 3 women studied, im injection of 150 mg of DMPA yielded brief initial serum MPA concentrations ranging from 1.5 to 3 ng/ml for a few days. Serum MPA concentrations gradually declined and remained relatively constant at about 1 ng/ml for 2 to 3 months, declined gradually thereafter reaching 0.2 ng/ml during the 6th month and became undetectable (less than 0.02 ng/ml) about 7-1/2 to 9 months following administration. Serum estradiol remained at early to midfollicular phase levels for 4 to 6 months after DMPA injection and rose to preovulatory levels when serum MPA levels fell below 0.5 to 0.25 ng/ml. Ovulation, however, as evidenced by serum progesterone concentrations did not occur, apparently due to suppression of the LH peak by positive feedback inhibition. Prolonged inhibition of cyclic ovarian function following DMPA injection is caused by slow MPA absorption and persists until serum MPA levels have decreased below 0.1 ng/ml or become undetectable about 7 to 9 months after DMPA administration.

Adult↗

PubMed1977

Clinical pharmacokinetics of lorazepam. II. Intramuscular injection.

A single dose of 4 mg of lorazepam was injected into the deltoid muscles of six healthy male volunteers. Multiple venous blood samples were drawn during 48 hr after the dose and all urine was collected for 24 hr after the dose. Concentrations of lorazepam and its major metabolite, lorazepam glucuronide, were determined by electron-capture gas-liquid chromatography. Lorazepam was rapidly absorbed from the injection site, reaching peak concentrations within 3 hr. Mean pharmacokinetic pamrameters for unchanged lorazepam were: apparent absorption half-life: 21.2 min; elimination half-life: 13.6 hr; volume of distribution: 0.9 L/kg; total clearance: 58.2 ml/min. Lorazepam glucuronide rapidly appeared in plasma, reached peak concentrations within 12 hr of the dose, then was eliminated approximately in parallel with the parent drug. Within 24 hr a mean of 47.6% of the dose was recovered in the urine as lorazepam glucuronide and less than 0.5% was recovered as unchanged lorazepam.

Adult↗