Steroids post injection pain

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I am a pediatrician by profession. I recently administered a 3rd dose of intramuscular injection of antibiotic Amikacin 500 mg (2ml in volume) to my 81 years old father. He immediately shouted that unlike previous two shots, third shot of intramuscular amikacin was quite painful and hurting. I took no serious note of it. However, after 24 hours, my father showed me his right gluteal region which was visibly swollen and tender on palpation. Worryingly, my examination revealed a roundish nearly 6 by 6 cms fixed yet mobile firmish swelling which was slipping below finger at its edge and was reasonably tender. However, overlying skin temperature was normal and there was no redness as compared to other gluteal region. a mild spike of 99 degree F was noted on day 2 of swelling. Though, I was worried about possibility of local infection, yet use of sterile syringe, adequate skin preparation with spirit and rapidity of onset of swelling within first 24 hours of intramuscular injection along with normal overlying skin were strong odds against infection. I presumptively diagnosed it as intramuscular hematoma and started monitoring it for further progress or resolution. From day 2 onward, I prescribed him hot water bottle fomentation twice daily ( 2-3 hours per session) and also gave tab serratiopeptidase 5 mg once daily (due to his underlying nephropathy) for next 3 days. After 72 hours of treatment, my father reported significant symptomatic improvement in local pain and size of swelling. My father discontinued further hot fomentation and intake of serratiopeptidase. His last examination at 2 weeks after IM injection showed almost marked resolution of swelling which was reduced to nearly 2 by 2 cms in dimension with no local tenderness. In the hindsight, I strongly feel clinically that it was intramuscular hematoma following amikacin injection which was accidentally repeated on same side of previous injection.

Steroids post injection pain

steroids post injection pain


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