Seventy-five patients with primary knee osteoarthritis (Kellgren Lawrence grades II-IV) were randomized to receive corticosteroid injections (80 mg Kenalog) with either no bupivacaine (n=25), 2 ml of 0.25% bupivacaine (n=25), or 4 ml of 0.25% bupivacaine (n=25). The primary outcome of interest was pain reduction, measured using the Visual Analog Scale (VAS) at several time points. Outcomes were assessed immediately before and after the injection, at 2 minutes, 1 day, 2 weeks, 6 weeks, and 12 weeks post-injection. Overall, the results of the study revealed no significant differences in VAS pain scores among the groups at any time point (p > .05), with all groups achieving the greatest pain relief at 1 day post-injection. These findings suggest that adding bupivacaine to corticosteroid injections provides no additional benefit and raises questions about its routine inclusion.