Lidocaine Dosing for Shoulder Triamcinolone Injection
Add 4 mL of 0.5% lidocaine (or 2 mL of 1% lidocaine) to 40 mg triamcinolone for standard shoulder injection, based on the most common effective protocol used in clinical practice.
Standard Mixing Protocol
The evidence supports a straightforward approach:
- Mix 4 mL of 0.5% lidocaine with 1 mL of triamcinolone 40 mg/mL for glenohumeral or subacromial injection 1
- Alternatively, 2 mL of lidocaine combined with 2 mL of bupivacaine and 80 mg triamcinolone has been used successfully, though this represents a higher steroid dose 2
- The 40 mg triamcinolone dose is superior to lower doses (10 mg) for symptom relief in shoulder pathology 3
Safety Considerations
When calculating your total lidocaine dose, remember these critical limits:
- Maximum safe dose without epinephrine is 4.5 mg/kg in adults 4, 5
- Maximum safe dose with epinephrine increases to 7 mg/kg 4, 5
- Calculate based on ideal body weight, not actual body weight 4
For a typical 4 mL injection of 0.5% lidocaine, you are administering 20 mg total lidocaine (0.5% = 5 mg/mL × 4 mL), which is well within safe limits for most adults 1.
Important Timing Precautions
- Wait at least 4 hours between this injection and any other local anesthetic intervention to prevent cumulative toxicity 6, 5
- Monitor for early toxicity signs including circumoral numbness, facial tingling, and slurred speech 6, 5
Clinical Context
The 4 mL of 0.5% lidocaine with 40 mg triamcinolone mixture has demonstrated effectiveness in multiple shoulder pathologies including frozen shoulder and rotator cuff-related pain 1, 7. This volume provides adequate local anesthesia while maintaining safe systemic absorption levels for intra-articular or subacromial administration.