Normal Saline Infiltration Research Articles

Normal saline infiltration as a treatment of steroid injection induced tissue atrophy: A clinical study

Introduction and Aim: Intramuscular steroid injection is a technique often used by unqualified village practitioners to control symptoms of a variety of disease processes. Such injudicious use of high dosages of steroids results in local side effects. Such side effects include occurrence of tissue atrophy at the site of injection. The treatment of such tissue atrophy includes filling up the gap with injection of autologous fat and other materials. However, these are expensive and require specialised set up. Normal saline infiltration into the atrophic area at varying intervals has been successfully tried by several authors in the past. The aim of the study was to find the efficiency and side effects of normal saline infiltration into acquired lipoatrophy areas as a method of treatment. Material and Methods: After informed consent, normal saline was infiltrated into the defect till sufficient tumescence was obtained. Results: Nine children were treated. Most of them had received steroid injections for exacerbation of childhood asthma. The defect had appeared shortly (2 to 4 months) after the last injection was received. The site of the defect was rounded and located on the deltoid region in the majority. Our success rate was 66%. The determination of the success rate of this technique and the factors contributing to the success of the technique requires more studies in this field. Conclusion: Normal saline infiltration is a safe and effective way for treating steroid injection induced skin and tissue atrophy.

Management of Lateral Epicondylitis: A Prospective Comparative Study Comparing the Local Infiltrations of Leucocyte Enriched Platelet-Rich Plasma (L-aPRP), Glucocorticoid and Normal Saline.

Introduction:Lateral epicondylitis is a painful condition of the elbow, characterised by pain and tenderness with resisted wrist extension. This study was carried out to evaluate the comparative efficacy of the local infiltration of L-PRP, methylprednisolone and normal saline in patients with lateral epicondylitis.Materials and methods:Sixty adult patients, between the ages 30 to 50 years, diagnosed with lateral epicondylitis of more than 12 weeks, were enrolled in the prospective randomised study. Their medical history and previous conservative treatment were recorded; the clinical evaluation of the tendinitis was made with the visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) outcome scores, the modified elbow performance index (MEPS), the functional assessment by patient-rated tennis elbow evaluation (PRTEE), together with the laboratory investigations. The patients were randomised using the computer-generated alphabets into three groups of 20: group A received saline, group B received PRP, and group C received corticosteroids.Results:Patients were seen at 4, 8 and 12 weeks to evaluate the post-injection status. VAS, DASH, and PRTEE scores were significantly reduced, and MEPS was significantly improved in group B compared to group A and group C. Moreover, the reductions in VAS and PRTEE were significantly different in group C compared to group A.Conclusion:PRP leads to superior healing with long-term therapeutic advantages compared to corticosteroids though it takes a little longer to have its effect.

A comparative clinical trial of vaginal misoprostol versus intracervical normal saline infiltration as a cervical ripening agent at time of hysteroscopy.

To compare the efficacy of vaginal misoprostol and intracervical normal saline infiltration as cervical ripening agents. A randomized comparative clinical trial had been conducted in AL Yarmouk Teaching Hospital involving two methods for cervical ripening before the hysteroscopic procedure. One Hundred women were enrolled in the study, fifty of them were those who used preoperative vaginal misoprostol and the other fifty patients were those who had been submitted to intracervical normal saline infiltration during surgery. Basal cervical dilatation, time to achieve 8 mm cervical dilatation, difficulties, and complications encountered during the procedure were evaluated and compared for both groups. The participants had been admitted for hysteroscopy for the following indications: Abnormal uterine bleeding, missed loop, infertility, polypectomy, endometrial resection, and myomectomy. Regarding operative findings, the basal cervical dilatation was not significantly different between them, the time required to achieve the required dilatation was significantly shorter for the normal saline infiltration group, 66.95 sec. ± 10.85 than for the misoprostol group which was 87.9 sec. ± 13.11. There was more difficulty in dilatation with more complications in the misoprostol group than in the normal saline infiltration group. Normal saline infiltration is a simple, readily available at the time of surgery and with fewer complications and shorter time of dilatation in comparison to vaginal misoprostol for a comparable efficacy.

Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia.

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in post-tonsillectomy analgesia. Over a period of 1year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24h post operatively. Using Mann-Whitney non-parametric statistical test, inter-group analysis was done which showed highly significant p-value (<0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial.

Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

The safety of one-per-mil tumescent infiltration into tissue that has survived ischemia.

BackgroundThe aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation.MethodsForty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension (TcPO2) was measured before and after infiltration, and changes in TcPO2 were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation.ResultsThirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. TcPO2 readings showed significant decreases (P<0.05) following both one-per-mil tumescent (99.9±5.7 mmHg vs. 37.2±6.3 mmHg) and normal saline (103±8.5 mmHg vs. 48.7±5.9 mmHg) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis.ConclusionsOne-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.

Abstract: A Randomized Placebo-Controlled Double Blind Study of Intercostal Nerve Block Versus Incisional Infiltration with Bupivacaine for Postoperative Pain Control after Subpectoral Breast Augmentation

INTRODUCTION: Breast augmentation is among the most popular surgery procedures performed in the Asian countries. Adequate pain control can have a substantial impact on morbidity and patient satisfaction. To date, no standard of care exists and management is based on surgeon preferences. The purpose of our study is to examine the role of intercostal nerve block and local bupivacaine injection in pain management following subpectoral breast augmentation. METHODS: This study was a prospective, randomized, placebo controlled double blind clinical trial with ethical approval. Thirty-two consecutive women undergoing subpectoral breast augmentation were enrolled. Patient received general anesthesia and were allocated randomly to two study groups. Patient in group 1 received intercostal nerve block using 10 ml of 0.25% bupivacaine with epinephrine in one side of the breast and normal saline in another side prior to implant placement. Patient in group2 received locally administered of 20 ml of 0.25% bupivacaine with epinephrine at the surgical site in one side of breast and placebo infiltration of normal saline in the contralateral breast. Both the patient and evaluator were blinded to the side given anesthesia and method of anesthesia used. Primary outcome was pain measured with the visual analogue scale recorded at 2, 6, 12, 24 and 48 hours at rest and after movement. Pain score was compared between breasts (anesthesia vs placebo) and between types of anesthesia. By comparing analgesic outcomes in the same patients, we could control for the subjectivity of pain assessments. A p-value of < 0.05 was considered statistically significant. RESULTS: Postoperative pain gradually decreased with time in all patients. No difference in pain scores was found over time at rest or on movement when comparing Intercostal nerve block to placebo or local infiltration to placebo. There was also no statistically significant difference in pain between intercostal nerve block and local infiltration of bupivacaine. All patients can return to normal activities within 48 hours after surgery. CONCLUSION: Our study did not demonstrate any statistically significant difference in postoperative pain when comparing those receiving intercostal nerve block versus placebo and those receiving local administered bupivacaine versus placebo. No beneficial effect of reducing postoperative pain demonstrated regardless of the type of local anesthetic used.

Voiding Function After Midurethral Slings With and Without Local Anesthetic: Randomized Controlled Trial.

This study aimed to compare the effect of periurethral infiltration of bupivacaine versus normal saline on postoperative voiding function and pain in patients undergoing retropubic midurethral sling METHODS: A randomized double-blind placebo-controlled study was performed at the University of Massachusetts from March 2012 to June 2015. Ninety patients were randomized to receive 0.5% bupivacaine with epinephrine or normal saline with epinephrine solution for periurethral hydrodissection. Postoperative pain was assessed at 2 to 3 and 6 to 7 hours using a visual analog scale. Voiding function was determined by the proportion of subjects passing or failing a voiding trial. Descriptive statistics and percentages were used to compare the rate of voiding dysfunction. A logistic regression analysis was performed adjusting for possible covariates. Ninety subjects enrolled and 45 were randomized to each group. Thirty-nine subjects received the normal saline and 41 received bupivacaine. The remaining 10 withdrew before the procedure. Pain scores at 2 to 3 hours did not differ between the groups (P = 0.837), but at 6 to 7 hours, patients who received bupivacaine had less pain (P = 0.028). There was no difference in voiding dysfunction between the study and placebo groups (17.9% and 24.4%, respectively; P = 0.481). Because of the unavailability of indigo carmine midway through the study, 36 of 80 subjects received preoperative phenazopyridine for the assessment of ureteral patency. Three (8%) of these subjects failed their voiding trial compared with 19 (30%) of the patients who did not receive phenazopyridine (P = 0.010). The use of bupivacaine did not affect postoperative voiding function but had lower pain scores at 6 to 7 hours postoperatively. Preoperative phenazopyridine may reduce postoperative urinary retention.

Percutaneous Trigger Release in Non-Triggering Digits: Infiltration of Normal Saline into Tendon Substance to Induce Triggering.

Percutaneous trigger release is recognized as an effective minimally invasive procedure with a low complication rate. One prerequisite for percutaneous trigger release is a trigger of Quinnell Type II or higher; that is, a digit that is actively triggering. We describe an additional step in percutaneous trigger release, which enables the surgeon to perform the procedure in digits that are not actively triggering at the point of surgery. This step involves the infiltration of normal saline into the tendon substance distal to the A1 pulley in order to induce triggering.

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars.

In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2% lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10min before placement of the incision. The pain scores on VAS at 30min, 1, 4, 12h and 1day post-operatively was significantly lower in the Test group than in the Placebo group (p<.05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p>.05) on the 1st, 3rd and 7th post-operative days. The sub-mucosal injection of 0.5mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24h.

Transforming Growth Factor-β1 Induced Urethral Fibrosis in a Rat Model

We sought to develop a reproducible TGF-β1 injection technique to induce urethral fibrosis in the rat urethra. A total of 32 male Sprague Dawley® rats weighing 300 to 350 gm were anesthetized with ketamine/xylazine intraperitoneally. Using a 5 mm penoscrotal incision the rat urethra was exposed. In the experimental group varying doses of TGF-β1 (5, 10 and 25 μg) were injected in each side of the urethral wall. Normal saline infiltration was used in the sham treated group. Rats were sacrificed 2 and 4 weeks following TGF-β1 injection. Urethral specimens were stained with hematoxylin and eosin, and Masson trichrome, and Western blot evaluations were performed. Normal and strictured urethral tissues from patients were collected and evaluated in the same fashion. There was no evidence of urethral wall thickening or fibrosis in the sham treated group. Varied histological evidence of fibrosis was noted in all experimental groups. There was a significant increase in collagen type I expression 2 weeks after injection of 5, 10 and 25 μg TGF-β1. Collagen type III expression was significantly increased 2 weeks after injecting 10 and 25 μg of TGF-β1, which persisted to 28 days after injection. TGF-β1 injection can successfully generate a reproducible rat model of urethral spongiofibrosis. This technique is simple, inexpensive and reproducible. Our series is a proof of concept study. Additional studies in larger animals are needed to further confirm our findings.

Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy

BackgroundKetamine, an N-methyl-D-aspartate receptor antagonist, can suppress hyperalgesia and allodynia. The purpose of the present study was to evaluate the clinical efficacy of preincisional intravenous or subcutaneous infiltration of ketamine for postoperative pain relief after appendectomy.MethodsNinety patients, aged 18–60 years, scheduled for appendectomy was enrolled in this study. Patients were divided into three groups of 30 each and received subcutaneous infiltration of ketamine 0.5 mg/kg (KS), intravenous ketamine 0.5 mg/kg (KI), or subcutaneous infiltration of normal saline 3 mL (C) before surgery. Visual analog scale (VAS) values and analgesic consumption were evaluated for 24 hours after surgery.ResultsVAS scores were significantly lower at the time of arrival in the recovery room, and at 10, 20, and 30 minutes thereafter in group KI and group KS compared with group C (P < 0.05). VAS scores were not significantly different between group KI and group KS at these intervals. Postoperative VAS scores were significantly lower at 6, 12, 18, and 24 hours in group KI compared with group C (P < 0.05). In group KS, the postoperative VAS score was significantly lower at 6 hours (P < 0.05). VAS scores were significantly lower at 12, 18, and 24 hours after surgery in group KI compared with group KS (P < 0.05).ConclusionA 0.5 mg/kg dose of ketamine given at approximately 15 minutes before surgery by the intravenous route provided analgesia for 24 hours after surgery in patients undergoing appendectomy.

Pre-Incisional Analgesia with Intravenous or Subcutaneous Infiltration of Ketamine Reduces Postoperative Pain in Patients after Open Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Study

In literature, there is controversy on the use of ketamine for management of postoperative pain. The aim of the present study was to evaluate the efficacy of pre-incisional intravenous or subcutaneous infiltration of ketamine on postoperative pain relief after open cholecystectomy. One hundred twenty patients, aged 18-60 years, scheduled for open cholecystectomy was enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into four groups of 30 each and received subcutaneous infiltration of ketamine 1 mg/kg (group KS1), subcutaneous infiltration of ketamine 2 mg/kg (group KS2), intravenous ketamine 1 mg/kg (group KI), or subcutaneous infiltration of normal saline 20 mL (group C) before surgery. Visual analog scale (VAS) values and analgesic consumption were evaluated for 24 hours after operation. VAS scores were significantly lower at arrival to the postanesthesia care unit, 15 and 30 minutes in Group KS1, Group KS2, and Group KI compared with Group C (P<0.05). In Group KS2, VAS scores were significantly lower than Group KS1 (P<0.05). Postoperative VAS scores were significantly lower at 1, 2, 3, 4, 8, 12, and 24 hours after operation in Group KS1, Group KS2, and Group KI compared with Group C (P<0.05). In Group KS2, VAS scores were significantly lower than Group KS1 (P<0.05). A 2 mg/kg dose of subcutaneous infiltration ketamine or 1 mg/kg dose of intravenous ketamine given at approximately 15 minutes before surgery provides an adjunctive analgesia during 24 hours after surgery in patients undergoing cholecystectomy surgery.

Evaluation of the Analgesic Efficacy of Local Dexmedetomidine Application

To determine the analgesic effects of locally applied dexmedetomidine in third molar surgery under general anesthesia. Patients undergoing bilateral third molar surgery under general anesthesia were recruited into this double-blind, randomized, controlled study and were allocated to 3 study groups. Group D received preincision intravenous dexmedetomidine (1 mcg/kg) and direct infiltration of normal saline to the surgical wounds at the end of the surgery. Group P received preincision intravenous normal saline and direct infiltration of dexmedetomidine (1 μg /kg) to the surgical wounds at the end of the surgery. A control group (group N) received normal saline at both time points. Postoperative analgesic effects, analgesic consumption, global pain satisfaction score, vital signs, adverse events, and postoperative recovery were assessed. Thirty-three patients from each group were studied. Postoperative resting pain numerical rating scale scores were similar in all the groups. However, the areas under curves of numerical rating scale pain scores during mouth opening for 1 to 72 hours were significantly lower in group P than in group N (P=0.012). Both heart rate and systolic blood pressure in the immediate postoperative period were significantly lower in groups D and P than in group N (P<0.001). Patients from groups D and P were also more sedated than patients in group N (P=0.013 and P=0.007, respectively) but no difference in psychomotor recovery was observed. Respiratory rate, oxygen saturation, common side effects, wound infection rate, and global pain satisfaction scores were similar among the groups. Dexmedetomidine seems to have an antihyperalgesic effect when administered locally after bilateral third molar surgery. There is no delay in psychomotor recovery or increase in postoperative clinically significant adverse events.

Gabapentin Premedication Decreases the Hemodynamic Response to Skull Pin Insertion in Patients Undergoing Craniotomy

In patients undergoing craniotomy, skull pin insertion produces significant increases in heart rate (HR) and blood pressure. We investigated whether premedication with gabapentin would prevent or attenuate this increase. Forty-seven ASA I and II patients, 18 to 60 years, undergoing elective craniotomy for intracranial tumor surgery were recruited prospectively and randomly divided into 3 groups; L (oral placebo plus 2% lidocaine infiltration at pin sites; n=12), G (oral gabapentin 900 mg plus normal saline infiltration; n=21) and GL (oral gabapentin 900 mg plus 2% lidocaine infiltration; n=14). The oral medications were administered 2 hours before induction of anesthesia. Measurements were made at preinduction baseline, before skull pin insertion and at every 1 minute from pin insertion till end of 10 minutes. Forty-three patients completed the study (L, n=11; G, n=20; GL, n=12). Premedication with gabapentin significantly attenuated the rise in systolic (SBP) and mean arterial pressure (MAP) after pin insertion when compared with placebo (for SBP, P<0.001 at 1 and 2 min and <0.05 at 3 to 5 min between L and G; P<0.001 at 1 to 4 min and <0.05 at 5 min between L and GL; for MAP, P<0.05 at 1 min, <0.001 at 2 min and <0.05 at 3 to 4 min between L and G; P<0.001 at 1 to 2 min and <0.05 at 3 to 5 min between L and GL). HR responses were also attenuated in patients premedicated with gabapentin; however, the responses were more variable in group G (P=0.03 between L and G at 4 min after pin insertion) as compared with group GL (P<0.05 at 1 min, <0.001 at 2 min and <0.05 at 3 to 10 min between L and GL). In conclusion, 900 mg of gabapentin, administered orally 2 hours before induction of anesthesia along with lidocaine scalp infiltration abolished the hemodynamic response after skull pin insertion. Premedication with gabapentin alone significantly attenuated the SBP and MAP; however, HR responses were more variable. A larger trial is required to corroborate the findings of the study before clinical recommendations would be warranted.

Letter: Treatment of Local, Persistent Cutaneous Atrophy After Corticosteroid Injection with Normal Saline Infiltration

Letter: Treatment of Local, Persistent Cutaneous Atrophy After Corticosteroid Injection with Normal Saline Infiltration

Letters to the Editor

Letters to the Editor

The Effect of Intraperitoneal Instillation and Trocar Site Infiltration of 0.25% Levobupivacaine on the Postoperative Pain after Performing Laparoscopic Cholecystectomy under Remifentanil Based Anesthesia

Background: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. Methods: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. Results: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). Conclusions: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC. (Korean J Pain 2008; 21: 44−50)

Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration

Injections of corticosteroids are commonly used for a variety a dermatologic conditions but may cause local, persistent cutaneous atrophy, with few therapeutic options. To determine the effectiveness of bacteriostatic normal saline infiltration on the improvement of corticosteroid-induced cutaneous atrophy. Four patients with corticosteroid-induced atrophy of the skin, two caused by acneiform cysts and one from intramuscular steroid injection, were treated with weekly injections of normal saline directly into the atrophic site. The patients were seen on weekly follow-up visits, and improvement was documented. All four patients demonstrated complete resolution of skin atrophy and restoration of surface contour within 4 to 8 weeks of initial presentation. Injected volumes of normal saline ranged from 5 to 20 cm(3) per treatment session and three to six weekly treatments. The patients were completely satisfied with these results. Normal saline infiltration offers a safe, tolerable, relatively rapid, and effective treatment for local, persistent corticosteroid-induced atrophy.

Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration

Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration