Lidocaine 1% for Trigger Point Injections
Yes, lidocaine 1% alone is effective and appropriate for trigger point injections, and is supported by clinical guidelines and research evidence.
Efficacy of Lidocaine 1% for Trigger Point Injections
Lidocaine 1% is widely used and effective as a standalone agent for trigger point injections. According to guidelines from the American Academy of Dermatology, lidocaine is a primary local anesthetic that can be used alone for infiltration techniques 1. The FDA label for lidocaine specifically indicates it for "production of local anesthesia by infiltration techniques such as percutaneous injection" 2.
Mechanism and Benefits
- Lidocaine blocks sodium ion channels required for the initiation and conduction of neuronal impulses, resulting in local anesthesia after application 1
- When used for trigger points, lidocaine provides both immediate pain relief and therapeutic benefit
- Studies show that lidocaine injections significantly decrease subjective pain symptoms and increase pain thresholds at trigger points 3
Dosing Considerations
When using lidocaine 1% for trigger point injections, follow these guidelines:
- Maximum safe dose: 4.5 mg/kg without epinephrine or 7 mg/kg with epinephrine 1, 4
- Typical volume: 1-2 mL per trigger point is generally sufficient
- Concentration options:
- Standard 1% lidocaine (10 mg/mL) is appropriate and effective
- Some evidence suggests that water-diluted 0.25% lidocaine (1:3 dilution of 1% lidocaine with sterile water) may provide better efficacy with less injection pain 5
Comparative Effectiveness
Research comparing different injection solutions for trigger points shows:
- Lidocaine injections are significantly more effective than placebo for myofascial pain syndrome 3, 6
- Lidocaine 2% is more effective than granisetron for reducing pain and disability in myofascial pain syndrome 6
- While botulinum toxin may have longer duration of effect in some cases, lidocaine is considered cost-effective and appropriate first-line treatment 7
Safety Considerations
When administering lidocaine for trigger point injections:
- Always aspirate before injection to avoid intravascular administration 2
- Monitor for signs of lidocaine toxicity, including circumoral numbness, facial tingling, dizziness, tinnitus, or visual disturbances 1, 4
- Use caution in patients with hepatic disease, cardiovascular impairment, or known drug sensitivities 2
- Reduce doses in debilitated, elderly, or acutely ill patients 2
Alternative Options
If lidocaine is contraindicated:
- For patients with true lidocaine allergy (rare), consider ester-type local anesthetics, 1% diphenhydramine, or bacteriostatic saline 1
- Dry needling (without any injectable solution) can be effective for some patients 7
Clinical Pearls
- Some clinicians add corticosteroids to lidocaine for trigger point injections, but this may actually increase injection-associated pain compared to using corticosteroid alone 8
- Intra-arterial lidocaine (up to 100 mg) can be used to reduce pain during certain procedures, but caution is needed to avoid cardiac arrhythmias 1
- For patients with severe or refractory myofascial pain, consider referral to a comprehensive pain rehabilitation center 1
Lidocaine 1% alone is a safe, effective, and appropriate choice for trigger point injections in myofascial pain syndrome, supported by both clinical guidelines and research evidence.