Joint injection

Usually involves injection of a combination of local anesthetics and corticosteroids.

Local anesthetics provide immediate analgesia and confirmation of accurate needle placement.

Corticosteroids typically used for joint infection are betamethasone sodium phosphate/acetate (Celestone), methylprednisolone (Depo-Medrol), tramcinolone acetonide (Kenalog) and tramcinolone hexacetonide (Aristospan).

0.75 mg of betamethasone equivalent to 5 mg of prednisone and it is supplied as 3 mg/mL suspension with doses based on joint size of 0.25-2 mL.

Methylprednisolone 4 mg equivalent to 5 mg of prednisone, with 4-10 mg injected for small joints and 20-80 mg for large joints.

t Triamcinolone acetonide 4 mg equivalent to 5 mg of prednisone with injection of large joints 5-15 mg and 2.5-5 mg for small joints.

Triamcinolone hexacetonide 4 mg equal to 5 mg of prednisone and large joint injections 10-40 mg are used and in small joints 2-6 mg.

Shortest acting corticosteroid agent is triamcinolone acetonide and longest acting is triamcinolone hexacetonide.

Longer acting corticosteroid agents have slightly higher risk of complications such as tendon rupture and tissue atrophy.

Local anesthetics utilized are bupivacaine, and lidocaine.

Bupivacaine has a significantly longer onset and duration of action than lidocaine.

Bupivacaine supplied in 0.25%, 0.5%, and 0.75% solutions and 1-2mL are used mixed with corticosteroids.

Lidocaine onset and duration proportional to dose injected.

Lidocaine 1-2% solutions generally used with 1-2 mL mixed with corticosteroids.

Complications include: bleeding rare, infection 1:1000 and joint injury of unknown incidence.

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