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Sacral Alar Notch Injection

PROCEDURE: Right sacral alar notch and sacroiliac joint/posterior rami injections with fluoroscopy.

ANESTHESIA: Local sedation.

VITAL SIGNS: See nurse’s notes.


DETAILS OF PROCEDURE: INT was placed. The patient was in the operating room with intravenous line in place and intravenous sedation was given. The patient was in the prone position. The back was prepped with Betadine. Under fluoroscopy, the right sacral alar notch was identified and after placement of a 22-gauge, 3-1/2 inch spinal needle in to the notch, negative aspiration was performed and 5 cc of 0.5% Marcaine plus 20 mg of Depo-Medrol was injected. The needle was then placed in to the right sacroiliac joint (distal third) and the same local anesthetic mixture was injected. This was repeated for the right sacral alar notch and the right sacroiliac joint (distal third). The needle was withdrawn. The above was repeated for the posterior primary rami branch at S2 and S3 by stimulating along the superior lateral wall of the foramen; then followed by steroid injection and coagulation as above.

There were no complications. Needles removed. Band-aids were applied over the puncture sites. The patient was discharged to operating room recovery in stable condition.

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