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Chronic inflammatory cytokines like interleukin-6 and tumor necrosis factor-alpha can suppress ovarian steroidogenesis by decreasing enzyme activity necessary to produce estrogen and progesterone

If a medication is to be administered via the intrathecal/epidural route, only preservative-free diluents (such as sterile saline or sterile water) are appropriate

Shift to green or brown, visible precipitate, or a metallic or ammonia-like smell indicates oxidation or copper dissociation

Aqueous solutions can be given with a 20- to 25-gauge needle

The report was uncontrolled, unblinded, not randomized, had no comparator arm, used patient-reported outcomes rather than validated pain instruments, and did not publish dose, effect size, confidence intervals, p-values, or systematically collected adverse events limitations that severely constrain any clinical inference