Local injectable anesthetics with corticosteroids

Generic Name: Local Injectable Anesthetics with Corticosteroids
Drug Class: Local injectable anesthetics with corticosteroids
Available Combinations:
Lidocaine + Methylprednisolone
Bupivacaine + Triamcinolone
Lidocaine + Dexamethasone
Ropivacaine + Betamethasone

Formulation: Injectable solution
Available Presentation: Single-use vials or multi-dose vials (depending on the agent), often mixed immediately before use in clinical settings
Route of Administration: Parenteral (intra-articular, epidural, perineural, trigger point, or soft tissue injection)

Mechanism of Action:
The local anesthetic component (e.g., lidocaine, bupivacaine) blocks sodium channels on neuronal membranes, preventing initiation and transmission of nerve impulses. This causes temporary loss of sensation and immediate pain relief.
The corticosteroid component (e.g., methylprednisolone, dexamethasone) penetrates cells, binds to glucocorticoid receptors, and modulates transcription of anti-inflammatory genes. This reduces inflammation, edema, and tissue irritation, leading to long-term pain control.

Therapeutic Use / Indications:
Used for pain and inflammation in musculoskeletal and neuropathic disorders such as:
– Osteoarthritis
– Bursitis
– Tendinitis
– Frozen shoulder
– Epicondylitis
– Plantar fasciitis
– Nerve root compression (radiculopathy)
– Sciatica
– Myofascial pain syndrome
– Carpal tunnel syndrome
– Sacroiliac joint pain

Common Side Effects:
– Localized pain at injection site
– Skin thinning or depigmentation
– Steroid flare (temporary worsening of symptoms)
– Transient hyperglycemia
– Facial flushing
– Infection (rare)
– Tendon rupture (rare with repeated use)
– Systemic steroid effects (Cushingoid features with excessive use)

Precautions:
– Avoid repeated injections into the same joint
– Use caution in diabetic patients due to possible elevation in blood glucose
– Avoid use in patients with systemic infection
– Monitor for allergic reactions
– Ensure correct injection technique to prevent nerve or vascular injury
– Ultrasound or fluoroscopic guidance recommended for deep or spinal injections
– Avoid particulate steroids for cervical epidural injections (risk of embolism)

Contraindications:
– Known hypersensitivity to local anesthetics or corticosteroids
– Active local or systemic infection
– Uncontrolled coagulopathy
– Local skin atrophy
– Known hypersensitivity to preservatives in multi-dose vials
– Intrathecal or intra-arterial injection with particulate steroids

Drug Interactions:
– Systemic corticosteroids: cumulative side effects
– Diabetic medications: may need dose adjustment due to transient hyperglycemia
– Anticoagulants: increased bleeding risk at injection site
– CYP3A4 inhibitors (e.g., ketoconazole): may increase steroid levels
– Neuromuscular blocking agents: enhanced effect if high systemic anesthetic exposure

Monitoring Parameters:
– Pain relief assessment
– Neurological status post-injection
– Blood glucose in diabetic patients
– Frequency of corticosteroid exposure
– Local signs of infection

Special Populations:
Elderly – Use with caution; start with lower doses
Pregnancy – Use only if clearly needed
Children – Limited data; use with caution
Diabetics – Monitor glucose for 24–72 hours post-injection

Storage:
Store individual agents as per manufacturer instructions
Anesthetic vials: room temperature
Steroid vials: room temperature or refrigerated depending on formulation
Once mixed, use immediately and discard unused portion

Examples of Commonly Used Agents:
Lidocaine 1% + Methylprednisolone acetate 40 mg
Bupivacaine 0.25% + Triamcinolone acetonide 40 mg
Ropivacaine 0.2% + Dexamethasone 8 mg