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If you have been sourcing from gray-market or "research use only" vendors: The risks are real and not hypothetical contamination, inaccurate dosing, and the absence of any clinical oversight

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

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

Patschan, D

Bacteriostatic Water Use 2.0 mL per 50 mg vial