Indications:

Intercostal neuralgia, herpes zoster; to relieve pain in rib fractures.

Materials:

Size 12 needle, 0.5–1 ml procaine or lidocaine.

Technique:

Point of insertion: Depending on the site of the pain: in the anterior section at the lower edge of the rib; in the posterior section further toward the middle of the intercostal space.

Direction of needle: Until the needle reaches the nerve.

Injection depth: 5–10 mm. When the patient signals a pain reaction, the needle is correctly in position.

Indications:

Any disorders in the area supplied by the sacral plexus; inflammation, pain, itching, sexual disturbances, hemorrhoids, sciatica; obstetrics. The sacral plexus supplies the following areas: Skin: Anus, perineum, scrotum, penis.

Organs: Lower rectum, vagina as far as the cervix of the uterus, ureter, pelvic floor, prostate, anal sphincter.

Materials:

1-mm-diameter × 60-mm-long needle, 5 ml procaine (20 ml in obstetrics).

Technique:

The patient stands hard against the examination couch, bent over forward at a right angle.

Point of insertion: About 20 mm above the cranial end of the natal cleft, the bony protuberances of the sacral cornua can be readily palpated; between them lies the resilient obturator membrane that closes the sacral hiatus. In adipose patients, the entry point is 40–50 mm cranially from the tip of the coccyx.

Direction of needle, injection depth: Insert the needle steeply through the upper part of the membrane, then depress the haft and slide the needle 40–60 mm further cranially up the sacral canal. The dural sac ends 60–90 mm beyond the point of entry.

CAUTION: Aspirate to check for the presence of blood or liquor!

Indications:

Sciatica, unilateral backache, prostatic and rectal disturbances, coccygodynia; sciatica-like pain in carcinoma of the prostate; sphincter spasm of the bladder.

Materials:

60-mm-long needle, 2–5 ml procaine or lidocaine.

Technique:

Point of insertion: The patient may either stand, or lies face down. The line connecting the two iliac crests intersects the spinous process of the fourth lumbar vertebra. Another two spinous processes further caudally is that of the first sacral vertebra. The first foramen lies two fingerbreadths laterally from the lower edge of this.

Injection depth: Insert the needle to a depth of 10–20 mm. The injection into the other foramina is given analogously.

CAUTION: Aspirate to check for the presence of liquor!

Indications:

a: Segmental therapy: In upper abdominal disorders affecting the stomach, intestine, liver, gallbladder, pancreas, kidneys.

b: Interference-field search: As a test injection, when an interference field is suspected after upper abdominal disorders.

Materials:

1-mm-diameter × 120-mm-long needle, 2–5 ml procaine or lidocaine.

Technique:

Point of insertion: The patient stands bent forward against a table or the head end of the examination couch. Palpate medially from the posterior axillary line along the lowest palpable rib until the edge of the long extensor muscles of the back can be felt about three fingerbreadths from the spinous processes. The entry point is here, between the edge of the rib and the edge of the muscle bundle. Let the patient breathe out fully and hold his/her breath, to ensure that the lower border of the lung moves up as far as possible.

Direction of needle: 30° medially and 60° cranially, i. e., obliquely upward, approximately in the direction of the normally situated contralateral nipple.

Injection depth: At a depth of ~ 80–100 mm, the needle seems to penetrate into a void after overcoming the resistance offered by the muscles and fascia. The celiac plexus lies ~ 10 mm further on.

CAUTION: Aspirate!

Indications:

Circulatory disturbances of the lower extremities, burns, frostbite, varicose ulcer, slow-healing amputation stumps, phantom-limb pains, post-traumatic osteoporosis.

Materials:

1-mm-diameter × 120-mm-long needle, 2–5 ml procaine or lidocaine.

Technique:

Point of insertion: The patient stands bent forward or lies down in a similar position. The line connecting the iliac crests crosses the spinous process of the fourth lumbar vertebra. From this reference point, choose the appropriate level for the injection; this is generally the second lumbar ganglion. The point of entry is three fingerbreadths laterally from the spinous process of the second lumbar vertebra.

Direction of needle: About 60° in a medial direction.

Injection depth: At a depth of ~ 30 mm the needle reaches the lateral process; to bypass this, raise the point of the needle and turn it to the side. At 70 mm the needle reaches the lateral surface of the vertebral body. Withdraw the needle and move it past this at a more oblique angle until bone contact with the convex surface of the vertebra is only just lost.

CAUTION: Aspirate!