Mr C was receiving treatment from his GP (Dr Q) for his left ureteric calculus. Dr Q administered 2ml of diclofenac into Mr C’s left buttock, but, immediately after the injection, Mr C complained of a burning sensation, pain and weakness in the left lower limb.
Dr Q checked the injection site and noted that the injection had been given 13cm lateral to the superior aspect of the natal cleft in the upper outer quadrant of the left buttock. The scab left by the previous injection was visible. Dr Q issued a prescription for painkillers and referred Mr C to hospital the following day, where he was treated for left ureteric colic and left foot drop.
Mr C brought an action against Dr Q, alleging that he had been negligent in administering the intramuscular injection.
An expert in general practice reviewed the case. In his opinion, the administration of diclofenac had led to immediate symptoms and signs that were compatible with sciatic nerve damage. He felt that the technique Dr Q had used in administering the injection had been of a standard below that expected of a reasonably competent medical practitioner.
‘[The] injection site needs to be chosen carefully to avoid striking the sciatic nerve, major blood vessels or bone. There are two methods of establishing an exact site, which is the upper outer aspect of the upper outer quadrant of the buttock approximately 5-8cm below the crest of the ileum.
‘It would be my opinion that the injection given … was placed in an area either at the infero-medial margin of, or perhaps even outside, the upper outer quadrant and was probably given at an angle aimed even more infero-medially than desirable.’
We negotiated an out-of-court settlement on behalf of Dr Q.
When administering or ordering IM NSAIDs:
- Follow the manufacturer’s instructions for administration (which usually specify deep injection into the upper outer quadrant of the gluteal muscle).
- Satisfy yourself that whoever is going to give the injection is suitably trained.