It's tough to keep up with the true steroid dosing due to the PCP's and ortho's giving medrol dosepacks and injecting joints. Nonetheless, we try our best to keep up with the total steroid load. I limit patients to less than 3 steroid injections in a 6 month period or 6 total per year. However, I've migrated most of my injections to depomedrol 20mg, or possibly 30mg (or 4-5 mg dexamethasone). There is decent data on lidocaine and possibly normal saline being just as important, if not more so, in the epidural space for radiculopathy and disc herniations. When I started practicing, I typically used 80mg depomedrol, then dropped to 40mg around 8-10 years ago, and now my dose is even lower. I've found lidocaine and using something to dilute / wash out the inflammatory milieu in the epidural space is just as important as the steroid. How many times do you see a snrb (no steroid) last 2-3 months? I have not seen a decrease in the length of relief by dropping the steroid dose. Also, we have a few patients who want a joint injection while they are having their ESI. I try to accommodate those patients by lowering the overall steroid dose in one or both injections, or changing to a visco injection, or suprascapular/ genicular / peripheral block if possible. Some of the most fragile patients we see are the older RA patients / COPD patients/ immunosuppressed patients who have received chronic year-round oral steroid dosing, so I try to be mindful of allowing adequate recovery between pulse doses of steroid for our procedures.