A call to Kenalog company office confirmed for me that it is the white precipitate that is the active ingredient. Letting the powder precipitate, and taking off the supernatant was shown to reduce preservatives by 43%. Simply adding Normal saline solution and letting it settle out again and removing that supernatant could reduce it much more. Of course when adding result to your subsequent injection, you would have to go on visual appearance to get right concentration.
Ahmad, M., et al. “A simple technique to reduce preservative related neurotoxicity in epidural corticosteroid injections.” Anesthesia & Analgesia 88.2S (1999): 269S.
- taking off supernatant reduced preservatives by 43%
When working with this you need to work with a BIG 5 ml vial.
let powder settle and take off liquid.
add Saline or D5W, let settle and remove liquid from that. What would be left would be much less likely to have much preservative.
Problem is, you will b e not sure of what concentration is left. However, one case I used it in (known allergy), I got some skin atrophy in shoulder so was obviously concentrated. Might have to look at how cloudy injection solution is, to get dosage.