CLINICAL REVIEW
Hanna Mass, BA; Haley Huddleston, PharmD, BA; Morteza Khodaee, MD, MPH
Corresponding Author: Morteza Khodaee, MD, MPH; University of Colorado School of Medicine, Department of Family Medicine.
Email: Morteza.khodaee@cuanschutz.edu
DOI: 10.3122/jabfm.2025.250381R2
Keywords: Bupivacaine, Intra-Articular Injections, Knee Joint, Lidocaine, Orthopedics, Osteoarthrosis, Pain, Rheumatology, Sports Medicine, Triamcinolone
Dates: Submitted: 09-30-2025; Revised: 10-11-2025; 12-08-2025; Accepted: 12-22-2025
Status: In Press.
BACKGROUND: Intra-articular corticosteroid injections are often combined with local anesthetics (LA) in the treatment of common conditions affecting the knee joint to provide immediate analgesia and diagnostic information as well as diffuse the corticosteroid injection and confirm accurate placement. Despite their common use, there is a lack of clear consensus and guidelines for the ideal anesthetic of choice leading to significant variation in practice patterns.
PURPOSE: This article provides an in-depth discussion regarding the use of LAs in combination with corticosteroids for knee injections including pharmacological properties, indications for use, current guidelines, and potential complications associated with use.
DATA EXTRACTION: We conducted a comprehensive literature search using Google Scholar and PubMed, employing various combinations of search terms and reviewing references of selected articles and key meta-analysis.
CONCLUSIONS: Despite the absence of clear clinical guideline consensus and variation in practice patterns, LAs in combination with corticosteroids can be beneficial for immediate pain relief and diagnostic support. Significant concerns have been raised regarding toxicity of LA to human chondrocytes and tenocytes though more research is needed to elucidate these findings and further characterize the optimal anesthetic of choice and dosage when used in combination with corticosteroids for knee injections.