Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications.

OBJECTIVE: To assess and evaluate the long-term safety of local anesthetic injections before or during games in professional rugby league players. DESIGN: Retrospective case series. SETTING: Professional rugby league team. PARTICIPANTS: Sydney Roosters players over a 6-year period (2008-2013), who had been administered a local anesthetic injection for an injury before or during a match to aid return to play. INTERVENTIONS: Follow-up survey (no active intervention). MAIN OUTCOME MEASURES: Player self-reported satisfaction. Survey results were compared with a previous cohort who had received local anesthetic injection from 1998 to 2007. RESULTS: Thirty-two players who had been injected with local anesthetic on 249 occasions for 81 injuries completed the current survey at an average of 5.64 years postinjection. In the cohort of 2008 to 2013, fewer injections were performed to areas deemed higher risk compared with the 1998 to 2007 cohort (P < 0.00002). The vast majority of players (80/81 cases) would repeat the injection in the same circumstances and reported that ongoing side effects were uncommon. There were 6 cases (8%) in which players reported significant ongoing pain in the area of injection at long-term follow-up. CONCLUSIONS: This study affirmed the long-term safety of injections in most cases. LEVEL OF EVIDENCE: IV.

Long-term safety of using local anesthetic injections in professional rugby league.

BACKGROUND: Local anesthetic pain-killing injections are commonly used by some professional football teams to allow continued play for certain injuries; however, the long-term safety of this practice has not been studied. HYPOTHESIS: The majority of local anesthetic injections administered in professional football are helpful and safe, not leading to long-term sequelae. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective survey was conducted of 100 players over 10 seasons who had been injected with local anesthetic on 1023 occasions for 307 injuries (81% follow-up; average follow-up, 5 years; minimum, 1 year). A comparison of match performance statistics was made from 3 seasons between players using and not using local anesthetic. RESULTS: The majority (98%) of players would repeat the procedure if they had their injury again, although 32% felt that there were side effects associated with the procedure (including 22% who thought that the recovery of the primary injury was delayed and 6% who thought that the injury was worsened by playing with local anesthetic). On long-term follow-up, only 6% of players had significant residual pain in the body part injected. The satisfaction rates for acromioclavicular injuries, finger injuries, rib injuries, and iliac contusions were higher than for sternum injuries, wrist injuries, and ankle injuries. Player performance between those players injected and not injected with local anesthetic was not substantially different and mainly reflected a positional bias for the players who used local anesthetic. CONCLUSION: The most commonly injected injuries-acromioclavicular joint sprains, finger and rib injuries, and iliac crest contusions-appear to be quite safe (in the context of professional sport) to inject at long-term follow-up. Conversely, ankle, wrist, and sternum injections appear to be less safe. A few injuries may have been substantially worsened by playing after an injection.