Does lidocaine reduce pain intensity during corticosteroid injection? A double-blind randomized controlled equivalence trial.

Of the strategies considered to limit the discomfort of corticosteroid injection, one is to inject without lidocaine to reduce the total volume and avoid acidity. In a Bayesian trial, adults receiving corticosteroid injections were randomized to receive 0.5 mL of triamcinolone with or without 0.5 mL of lidocaine. Serial analysis was performed until a 95% probability of presence or absence of a 1.0-point difference in pain intensity on the 0-10 Numerical Rating Scale was reached. Injections with lidocaine were associated with a median of 2.4-point lower pain intensity during injection with a 95% probability of at least a 1-point reduction. The 95% probability was confirmed in 90% of the repeated analysis (36/40). Lidocaine is associated with lower immediate pain intensity during corticosteroid injection for hand and wrist conditions. Level of evidence: I.
Competing Interests: Declaration of conflicting interestsThe authors disclosed the following potential conflicts of interests with respect to the research, authorship, and/or publication of this article: DR, or a member of their immediate family, has or may receive payments or benefits, in any one year, from Skeletal Dynamics for an internal joint stabilizer elbow in the amount of between US$10,000 and US$100,000 per year, from Wolter-Klewer between US$100 and US$1000 per year, that he is a Deputy Editor for Clinical Orthopaedics and Related Research and has received or may receive payments or benefits in the amount of US$5000 per year. One of the authors certifies that he (DR) received honoraria from various universities, professional associations and continuing medical education vendors. All other authors report no conflict of interest.