Skip to main content

Corticosteroids and Local Anesthetics

  • Chapter
  • First Online:
Musculoskeletal Injections Manual

Abstract

Corticosteroids and local anesthetics are two medications that have significantly impacted the structure of the medical field and improved patient care. Both categories of drugs have distinct histories and applications. Corticosteroids are synthetic drugs that mimic the effects of natural steroid hormones produced by the adrenal glands. Corticosteroids possess potent anti-inflammatory properties and are widely used to manage autoimmune and anti-inflammatory conditions with a wide application in the trauma and orthopedics fields especially for the injectable corticosteroids. Local anesthetics block nerve impulses in a specific area of the body, thus preventing pain signals from being transmitted to the brain. Over the years, corticosteroids and local anesthetics have undergone significant advancements in terms of formulation, delivery methods, and safety profiles. They continue to play a crucial role in modern medicine, providing relief to patients and enabling various surgical and medical interventions with reduced pain and inflammation. Especially, injectable corticosteroids and local anesthetics can be effective in the management of a variety of musculoskeletal conditions including tendonitis, tenosynovitis, bursitis, and osteoarthritis. Multiple knee joint disorders are frequently addressed with corticosteroids with or without local anesthetics injection. The use of corticosteroids should be carefully considered and monitored by a healthcare professional. Patients should also be informed of the potential risks and benefits of these medications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brown TCK. History of pediatric regional anesthesia. Paediatr Anaesth. 2012;22(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  4. Grinspoon L, Bakalar JB. Coca and cocaine as medicines: an historical review. J Ethnopharmacol. 1981;3(2–3):149–59.

    Article  CAS  PubMed  Google Scholar 

  5. Ring ME. The history of local anesthesia. J Calif Dent Assoc. 2007;35(4):275–82.

    PubMed  Google Scholar 

  6. Cole BJ, Schumacher HR. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13(1):37–46.

    Article  PubMed  Google Scholar 

  7. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711–23.

    Article  CAS  PubMed  Google Scholar 

  8. Corticosteroids. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012 [cited 2023 Apr 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK548400/

  9. Ostergaard M, Halberg P. Intra-articular corticosteroids in arthritic disease: a guide to treatment. BioDrugs. 1998;9(2):95–103.

    Article  CAS  PubMed  Google Scholar 

  10. Barletta M, Reed R. Local Anesthetics: pharmacology and special preparations. Vet Clin North Am Small Anim Pract. 2019;49(6):1109–25.

    Article  PubMed  Google Scholar 

  11. Nestor CC, Ng C, Sepulveda P, Irwin MG. Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review. Anaesthesia. 2022;77(3):339–50.

    Article  CAS  PubMed  Google Scholar 

  12. Ruetsch YA, Böni T, Borgeat A. From cocaine to ropivacaine: the history of local anesthetic drugs. Curr Top Med Chem. 2001;1(3):175–82.

    Article  CAS  PubMed  Google Scholar 

  13. Rastogi AK, Davis KW, Ross A, Rosas HG. Fundamentals of joint injection. AJR Am J Roentgenol. 2016;207(3):484–94.

    Article  PubMed  Google Scholar 

  14. Seshadri V, Coyle CH, Chu CR. Lidocaine potentiates the chondrotoxicity of methylprednisolone. Arthrosc J Arthrosc Relat Surg. 2009;25(4):337–47.

    Article  Google Scholar 

  15. Stephens MB, Beutler AI, O’Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. 2008;78(8):971–6.

    PubMed  Google Scholar 

  16. Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal injection. Mayo Clin Proc. 2009;84(9):831–6. quiz 837

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chou R, McDonagh MS, Nakamoto E, Griffin J. Analgesics for osteoarthritis: an update of the 2006 comparative effectiveness review [internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). 2011 [cited 2023 Apr 10]. (AHRQ Comparative Effectiveness Reviews). Available from: http://www.ncbi.nlm.nih.gov/books/NBK65646/

  18. Jüni P, Hari R, Rutjes AWS, Fischer R, Silletta MG, Reichenbach S, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;2015(10):CD005328.

    PubMed  PubMed Central  Google Scholar 

  19. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet Lond Engl. 2010;376(9754):1751–67.

    Article  CAS  Google Scholar 

  20. Šimurina T, Mraović B, Župčić M, Graf Župčić S, Vulin M. Local anesthetics and steroids: contraindications and complications—clinical update. Acta Clin Croat. 2019;58(Suppl 1):53–61.

    PubMed  PubMed Central  Google Scholar 

  21. Schairer WW, Nwachukwu BU, Mayman DJ, Lyman S, Jerabek SA. Preoperative hip injections increase the rate of periprosthetic infection after Total hip arthroplasty. J Arthroplast. 2016;31(9 Suppl):166–9.e1

    Article  Google Scholar 

  22. MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252(3):647–61.

    Article  PubMed  Google Scholar 

  23. Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG, Mörwald EE, et al. The third American Society of Regional Anesthesia and Pain Medicine practice advisory on local Anesthetic systemic toxicity: executive summary 2017. Reg Anesth Pain Med. 2018;43(2):113–23.

    Article  PubMed  Google Scholar 

  24. Sekimoto K, Tobe M, Saito S. Local anesthetic toxicity: acute and chronic management. Acute Med Surg. 2017;4(2):152–60.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Edd SN, Giori NJ, Andriacchi TP. The role of inflammation in the initiation of osteoarthritis after meniscal damage. J Biomech. 2015;48(8):1420–6.

    Article  PubMed  Google Scholar 

  26. Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5(3):351–61.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med. 2015;3(5):2325967115581163.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gitman M, Barrington MJ. Local Anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43(2):124–30.

    PubMed  Google Scholar 

  30. Rutjes AWS, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180–91.

    Article  PubMed  Google Scholar 

  31. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–74.

    Article  CAS  Google Scholar 

  32. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88.

    Article  CAS  Google Scholar 

  33. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;2:CD005328.

    Google Scholar 

  34. Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (nonarthroplasty), third edition. J Am Acad Orthop Surg. 2022;30(9):e721–9.

    Article  PubMed  Google Scholar 

  35. Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S. Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol. 1999;54(8):502–6.

    Article  CAS  PubMed  Google Scholar 

  36. Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labonté F, Beaudoin G, Bloch DA, et al. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis. 2005;64(4):556–63.

    Article  PubMed  Google Scholar 

  37. Ding C, Martel-Pelletier J, Pelletier JP, Abram F, Raynauld JP, Cicuttini F, et al. Knee meniscal extrusion in a largely non-osteoarthritic cohort: association with greater loss of cartilage volume. Arthritis Res Ther. 2007;9(2):R21.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Byrne C, Alkhayat A, Bowden D, Murray A, Kavanagh EC, Eustace SJ. Degenerative tears of the posterior horn of the medial meniscus: correlation between MRI findings and outcome following intra-articular steroid/bupivacaine injection of the knee. Clin Radiol. 2019;74(6):488.e1–8.

    Article  CAS  PubMed  Google Scholar 

  39. Coll C, Coudreuse JM, Guenoun D, Bensoussan L, Viton JM, Champsaur P, et al. Ultrasound-guided Perimeniscal injections: anatomical description and feasibility study. J Ultrasound Med. 2022;41(1):217–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ollivier, M., Mabrouk, A. (2024). Corticosteroids and Local Anesthetics. In: Kocaoglu, B., Laver, L., Girolamo, L.d., Compagnoni, R. (eds) Musculoskeletal Injections Manual. Springer, Cham. https://doi.org/10.1007/978-3-031-52603-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-52603-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-52602-2

  • Online ISBN: 978-3-031-52603-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics