From the FDA Drug Label
Injections should be made into the affected areas rather than into the surrounding tissues. If coadministration of a local anesthetic is desired, Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension may be mixed with 1% or 2% lidocaine hydrochloride, using the formulations which do not contain parabens. During epidural administration of bupivacaine hydrochloride, 0.5% and 0. 75% solutions should be administered in incremental doses of 3 mL to 5 mL
The local anesthetic and steroid combination used for cervical epidural steroid injections is bupivacaine and betamethasone. The typical volume is 3 mL to 5 mL 1 2.
From the Research
For cervical epidural steroid injections, a common local anesthetic and steroid admixture consists of 1-2 mL of a local anesthetic (typically 0.25-0.5% bupivacaine or 1-2% lidocaine) combined with 1-2 mL of a corticosteroid (such as methylprednisolone 40-80 mg, triamcinolone 40-80 mg, or dexamethasone 4-10 mg), with a total volume typically ranging from 2-4 mL. The choice of local anesthetic and steroid may vary based on patient factors and the practitioner's preference, as noted in a survey of Spine Intervention Society physicians 3. Some key considerations for the procedure include:
- The use of particulate versus non-particulate corticosteroids, with some studies suggesting a risk of embolization with particulate corticosteroids 4, 3
- The potential for crystalization of ropivacaine in the presence of dexamethasone, which could create a particulate-like injectate 3
- The importance of minimizing volume to reduce the risk of complications such as spinal cord compression or intrathecal spread, with some studies suggesting that high volumes (> 4.5 mL) may be used by some providers 3
- The pharmacokinetics of cervical epidural-administered triamcinolone, which has been shown to have a terminal elimination half-life of 219 hours 5 Overall, the goal of cervical epidural steroid injections is to provide pain relief and reduce inflammation, while minimizing the risk of complications. Some of the key medications used for this procedure include:
- Local anesthetics such as bupivacaine and lidocaine
- Corticosteroids such as methylprednisolone, triamcinolone, and dexamethasone The specific medication choice and volume used may vary depending on the individual patient and the practitioner's preference, as well as the results of studies such as those published in 2018 and 2019 6, 3.