Postinjection flare of pain

Postinjection flare of pain - The quoted figures are from about 2% to 10%6 3 , 6 4 , but this is well in excess of our own experience. When it does happen it is usually after a soft-tissue injection, and rarely follows joint injection6 4 . It appears to be caused by rapid intracellular ingestion of the microcrystalline steroid ester and must always be distinguished from sepsis2 8 , 3 1 , 3 6 , 2 6 0 . There appear to be more frequent postinjection flares with methylprednisolone but this might have more to do with the preservative in the drug than with the steroid itself5 7 . An early increase in joint stiffness following intra-articular corticosteroids is consistent with a transient synovitis1 7 9 . Multidose bottles of lidocaine (Xylocaine) contain parabens as a preservative. Many steroids will precipitate when added to parabens and this precipitate might be responsible for some cases of postinjection flare of pain and 'steroid chalk' (see below). Parabens might also be responsible for some allergic reactions to local injections. The use of multidose bottles increases the risk of cross-infection and should be avoided2 2 0 . Single-dose vials of lidocaine do not contain parabens.