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Access the full publication through NEJM.org for detailed methodology, adverse event data, and subgroup analyses

Bacteriostatic Water Use 2.0 mL per 50 mg vial

Having said that, there are some things that one can do that may reduce the likelihood of progressing to toxic levels: Ultrasound guidance may reduce the incidence, as one can more precisely target (and avoid vasculature) Use the lowest effective dose of local anesthetic (dose = volume x concentration) Incremental injection of local anesthetics, pausing between each injection (one circulation time) Aspirate before each injection (bear in mind there is a 2% false-negative rate for this diagnostic intervention) When injecting potentially toxic doses of local anesthetic, one can use of an intravascular marker

This rigorous approach ensures that IV therapy is only provided to those who will benefit most, and that it is delivered safely