in tra articular injection in the shoulder

Injection with local anaesthetic

Injection with local anaesthetic

By Dr. Jan Claeys, M.D.

Indications of infiltration techniques with local anaesthetic

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The anaesthetizing effect of procaine starts after 5-10 min. and lasts about 45 min. The maximal quantity should not exceed 50 ml in a 0.5 % concentration.

Procaine is used in concentrations of 0.5 % and 2 %.


The anaesthetizing effect starts after 2 min. and lasts about 60 min.

Lidocaine is used in a 2 % concentration.

Procaine 0.5 % is used as a diagnostic aid, but also therapeutically in cases of chronic bursitis, muscle belly lesions and in epidural local anaesthesia.

Procaine 2 % is used to dissolve calcium deposits in tendons or bursae, and in case of a sinuvertebral nerve block.

Lidocaine 2 % without ADR is used as a diagnostic aid, and for superficial anaesthesia of the skin in epidural local anaesthesia.

When using local anaesthetics, both a toxic and an allergic reaction can occur.

  • Toxic reaction

This reaction presents mainly when the maximal dose is exceeded or in intravenous application of the anaesthetic.

Either a stimulation or a depression of the central nervous system occurs, in conjunction or not with a cardiovascular suppression.

Next to an immediate reaction, also a delayed one is possible ; it occurs 5-30 min. after the injection. Therefore, after an epidural local anaesthesia, the patient must be kept under observation for another 30 min.

  • Allergic reaction

Its frequency, when using procaine, is 1/50.000.

Besides the general urticarian reaction, a serious anaphylactic shock can occur, fortunately only very exceptionally with respiratory and cardiac arrest.

Next to an immediate reaction, also a delayed one is possible, as long as 30 min. after the application.

Previous interrogation of the patient as to the presence of an allergy can help avoiding allergic reactions ; in case of doubt, a small intradermal application can be considered.

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