Answer
Local anesthesia is always warranted. After skin preparation, draping, and identification of the needle insertion site, use a 25- or 27-gauge needle to inject 2-5 mL of local anesthetic (eg, lidocaine 1%) into the subcutaneous tissue (see the image below). (See Local Anesthetic Agents, Infiltrative Administration.) Deep injections that might enter the joint space are not recommended, because they may alter the synovial fluid analysis results.
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Media Gallery
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Anterior view of right knee.
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Anatomic landmarks for knee arthrocentesis.
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Infiltration of local anesthetic via medial parapatellar approach (left knee).
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Left-knee aspiration via medial parapatellar approach.
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Application of bandage after left-knee aspiration.
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