Methylprednisolone with lidocaine

How it works

Methylprednisolone acetate is a depot glucocorticoid that suppresses local inflammatory mediators within the injected tissue, while lidocaine is an amide local anaesthetic that reversibly blocks neuronal sodium channels to provide short-term pain relief.

Prescribing in practice

• Do not inject into or through infected tissue or a potentially septic joint, as introducing depot steroid into infection can have serious consequences, and exclude lidocaine hypersensitivity.
• Use strict aseptic technique and avoid repeated frequent injections into the same site because of the risk of tissue and cartilage atrophy and local depigmentation.
• Account for the systemic effects of absorbed steroid in patients with diabetes, hypertension or on other corticosteroids, and be aware lidocaine adds a small systemic local-anaesthetic load.

Monitoring

Observe the patient briefly after injection for local reaction or local-anaesthetic effects, and review the joint or soft tissue for response and any signs of post-injection infection.

Counselling the patient

• Expect short-lived numbness from the anaesthetic, then a possible brief flare before benefit.
• Rest the injected area for a day or two and seek help if it becomes hot, swollen or increasingly painful.
• Tell the clinician if you have diabetes, as blood glucose may rise transiently.

Evidence & guidelines

Depot corticosteroid with local anaesthetic injections are standard practice for inflammatory joint and soft-tissue conditions, supported by rheumatology and musculoskeletal guidance in the UK.