and to exclude intravascular placement. The amount of contrast necessary to reach the intended structures to treat will determine the optimal volume of injectate to use for the specific diagnostic injection.

• The injectate solutions should be preservative-free solutions to avoid potential seizures and arachnoiditis.

• Small particulate steroids such as triamcinolone acetonide are used for injections of the lumbar spine.

• Fine particulate steroids such as betamethasone or non-particulate steroid injectates that are usually prepared by specialized pharmacies and are not commercially available are used for injections of the cervical spine.

Sterility is another important consideration. Observation of aseptic local technique is fundamental for these procedures. It implies sterile gloves and equipment and the formation of a sterile field after aseptic preparation of the skin. Generally three Betadine passes are used as well as alcohol or Hibiclean scrub.

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