Adverse events associated with local anaesthetic use in musculoskeletal injection therapy: a scoping review

Background

Musculoskeletal disorders (MSDs) are a leading cause of disability worldwide and account for a substantial proportion of healthcare utilisation. Injection therapy combining corticosteroids with local anaesthetic (LA) is widely used for MSD management, including within physiotherapy practice. Despite widespread use, uncertainty remains regarding the safety profile of LAs and the potential risk of adverse events.

Objective

To map the available evidence on adverse events and associated risk factors following local anaesthetic use in the management of musculoskeletal disorders.

Methods

A scoping review was conducted following Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, CINAHL, PubMed and Cochrane were searched from database inception to 2025, alongside targeted grey literature searching. Studies reporting adverse effects of LAs administered for musculoskeletal conditions within physiotherapy scope of practice were included. Data were extracted by multiple reviewers and synthesised thematically.

Results

39 sources were included. Cytotoxicity, particularly chondrotoxicity, was the most frequently reported adverse effect, appearing in 74% of included sources. Evidence indicated reduced chondrocyte viability, mitochondrial dysfunction and apoptosis following exposure to commonly used agents such as lidocaine and bupivacaine. Systemic toxicity, allergic reactions and psychogenic responses were reported less frequently. Key risk factors included higher dose or concentration, prolonged exposure duration, continuous intra-articular infusion, patient comorbidities and accidental intravascular injection.

Conclusion

Evidence on adverse effects of LA use in MSD management is heterogeneous but consistently highlights cytotoxicity as a potential concern. Further clinical research is required to quantify risk and guide safer injection practices.