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| COMMENTARY |
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| Year : 2019 | Volume
: 67
| Issue : 7 | Page : 92-93 |
Indiscriminate use of intramuscular injections: An unforeseen public health hazard
Anil Kumar1, Debora Garozzo2, Dhaval P Shukla3
1 Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Brachial Plexus and Peripheral Nerve Surgery Unit, Neuro Spinal Hospital, Dubai, United Arab Emirates
3 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| Date of Web Publication | 23-Jan-2019 |
Correspondence Address:
Dr. Anil Kumar
All India Institute of Medical Sciences, Raipur, Chhattisgarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.250707
How to cite this article:
Kumar A, Garozzo D, Shukla DP. Indiscriminate use of intramuscular injections: An unforeseen public health hazard. Neurol India 2019;67, Suppl S1:92-3 |
Intramuscular injection is an often abused form of medical intervention in developing countries and injection nerve injuries constitutes a public health hazard. Iatrogenic injection injuries are the most common (52.9%) of all nerve injuries in children and they are due to a faulty technique or an improper site selection.[1] In a retrospective study, it was found that 70% of the patients received intramuscular injections from persons other than trained health professionals.[2] The need to discourage the indiscriminate use of intramuscular injections and the choice of a proper site of injection should be stressed, as prevention of these iatrogenic injection injuries is the most important aspect of management.[3],[4] Parents often insist that their children be relieved immediately of pain or fever, and for this reason, medical staff prefer to give an injection over medication. In the lower limbs, the intramuscular injection is usually given in the upper and outer quadrant of the buttock. It is suggested that intramuscular injections be given in the anterior aspect of the thigh, where nerve injury is unlikely. If the injection has to be administered into the buttock, the ventrogluteal site has a more favourable safety profile than the dorsogluteal site as it is more difficult to reach the sciatic nerve with a needle in this position than with the dorsogluteal approach. In the case of the upper limbs, the injection should be given in the superficial pinna of the deltoid muscle to avoid injury to the radial nerve and the axillary nerve. The anterolateral thigh in infants and the deltoid muscle in older children should be used for intramuscular injections and the buttock should be avoided. Injection nerve injury results in either intraneural or perineural injury. The degree of injury depends on the angulation of the injection, e.g., if the angle to the skin surface is 90° then the depth of penetration will be greater and it will cause intraneural injury resulting in an immediate effect with moderate to severe neurological deficits. However, if the angulation is less than 90°, then injury will occur around the perineural area and it will have a delayed presentation with mild to moderate neurological deficits.[1]
There is no consensus in the literature regarding the exact timing of surgery in cases of delayed recovery; however, a good recovery (81.8%) has been demonstrated following an early surgery (<6 months) in comparison to a delayed surgery (50%) [P = 0.03].[1]
In this issue of Neurology India, Desai et al., publish a surgical experience of 354 operated cases of injections related iatrogenic peripheral nerves injuries.[5] Like the findings of the earlier studies, they found that functional recovery was significantly better when the patients were operated within 6-months from the time of injury. The results of this study also supports the literature and showed a better outcome with neurolysis when compared with nerve grafting procedures i n all types of injection palsies.
In conclusion, the outcome of injection nerve injury is generally good and many patients recover spontaneously. However prevention of nerve injuries due to intramuscular injections cannot be over-emphasized and reducing injection nerve injuries should be a priority. It is critical to raise awareness among medical professionals to recognize the signs of nerve injury, provide basic care, and know when to refer the injured patient to a peripheral nerve surgeon, as timely surgical treatment is the best option for recovery.
| » References | |  |
| 1. | Devi BI, Konar SK, Bhat DI, Shukla DP, Bharath R, Gopalakrishnan MS. Predictors of surgical outcomes of traumatic peripheral nerve injuries in children: An institutional experience. Pediatr Neurosurg 2018;53:94.  |
| 2. | Kakati A, Bhat D, Devi BI, Shukla D. Injection nerve palsy. J Neurosci Rural Pract 2013;4:13-8. [ PUBMED] [Full text] |
| 3. | Shukla DP, Bhat DI, Devi BI, Gopalakrishnan MS, Moiyadi A. Injection injuries of peripheral nerves. Indian J Neurotrauma 2004;1:21-3 |
| 4. | Agarwal A, Mirza A, Gulati A, Gulati P. Post injection sciatic nerve injury: MRI. Neurol India 2019;67:S157-8. |
| 5. | Warade AC, Jha AK, Pattankar S, Desai K. Injection-related iatrogenic peripheral nerves injuries-Surgical experience of 354 operated cases. Neurol India 2019;67:S82-91. |
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