Some patients report adverse reactions to steroid/ local anesthetic injections used frequently for pain control. We describe skin testing results of patients presenting with local or systemic reactions to a combined steroid/ local anesthetic injection. Retrospective analysis of 105 patients who had local anesthetic and/or steroid skin testing at Mayo Clinic from 01/2004 to 07/2012. We identified 23 patients who reported either a systemic or local reaction to a steroid/ local anesthetic injection. Of these, 5 patients were tested only to local anesthetics and all 5 tests were negative. 18 patients were tested to both steroids and local anesthetics and overall 44% (8/18) of these skin tests were positive. 62.5% (5/8) of positive tests were positive reactions to a steroid, 12.5% (1/8) was positive to a local anesthetic- lidocaine, and 25% (2/5) were positive to both a steroid and a local anesthetic. In only 2 cases (with triamcinolone and lidocaine), the drug causing the historical reaction correlated with the drug resulting in a positive skin test. In 5 cases the medication causing the historical reaction was not the same medication resulting in a positive skin test and in the remaining 1 case the historical steroid and local anesthetic were unknown. In cases of adverse reactions to combined steroid/ local anesthetic injections the steroid component resulted in a positive skin test significantly more often than the local anesthetic. However in only 25% of patients was there a confirmatory positive skin test to one of the agents causing the historical reaction.
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