Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

Abstract

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients' psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks; comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site 375 Open Journal of Psychiatry adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review

“…For example, when obese individuals received Risperidone subcutaneously rather than intramuscularly, they experienced little to no therapeutic effectiveness in schizophrenia treatment (Sakamaki et al, 2013;Tanioka et al, 2013;Wynaden et al, 2015;Yasuhara et al, 2012;Zhao et al, 2017).…”

“…There are no prescribed guidelines for choosing the correct needle length based on an individual's BMI and sex (Carrell et al, 2001;Young et al, 2013;Zhao et al, 2017).…”

“…Vaccines, epinephrine, antibiotics, oncology and antipsychotic medications, and hormones are among a few that if given into SAT, do not absorb enough to deliver the amount of medication necessary to adequately medicate patients (Bhalla et al, 2013; Middleman et al, 2010; Shah et al, 2014; Tanioka et al, 2013; Weber et al, 1985). For example, when obese individuals received Risperidone subcutaneously rather than intramuscularly, they experienced little to no therapeutic effectiveness in schizophrenia treatment (Sakamaki et al, 2013; Tanioka et al, 2013; Wynaden et al, 2015; Yasuhara et al, 2012; Zhao et al, 2017).…”

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

“…Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention [1] [2] [3] [4]. However, there are dangers such as vascular damage, muscle contracture, nerve injury due to IM injection [5] [6] [7] [8] [9], and injections site reactions such as redness and swelling, which may occur [10] [11]. In particular, oily formulation LAIs, which have been designed so that the drug metabolizes in the muscle, contain aspects warranting careful attention, such as being more irritant than the usual medicines [12], and having a higher viscosity.…”

“…As such, the current IM injection method has its limitations, featuring a multitude of problems in terms of ensuring medical safety and establishing a proven IM injection technique. The authors' research team has experience in the use of ultrasound diagnostic devices to conduct analysis of drug luminance changes post-IM injection [17], the relationship between injection site reactions and treatment efficacy according to IM injection needle penetration depth [11], and research involving appropriate and safe needle penetration length in IM injections [15] [18] [19] [20]. Data were obtained from 136 patients undergoing treatment with LAI and 83 healthy subjects by ultrasonogra-T. Tanioka et al phy at four psychiatric hospitals and one psychiatric clinic in Japan.…”