Ultrasound-guided Medial Branch Blocks, Facet Joint, and Multifidus Muscle Injections: How It Is Done under One Needle Insertion Point!
Carl P. C. Chen, M.D., Ph.D.; Jean-Lon Chen, M.D., Ph.D.; Chan-Shien Ho, M.D.; Areerat Suputtitada, M.D.
 Author Notes
From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan (C.P.C.C., J.-L.C., C.-S.H.), and the Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.S.).
Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
Correspondence: Address correspondence to Dr. J.-L. Chen: bigmacpaper@gmail.com
Anesthesiology Newly Published on October 31, 2019. doi:10.1097/ALN.0000000000003043
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Lumbar facet joint injections and medial branch blocks can be performed under computed tomography guidance.1  Musculoskeletal ultrasound has been shown to be an accurate guiding tool in performing these procedures as well.2  Song et al. have suggested that the lumbar multifidus muscle can be injected under ultrasound guidance in an out-of-plane approach.3  No publication has shown how to perform ultrasound-guided lumbar medial branch block, facet joint, and multifidus muscle injections under one needle insertion point. With the patient placed in a prone position and a pillow under the abdomen, a low-frequency curvilinear transducer is placed in a transverse plane to obtain the transverse paravertebral sonogram of the low back (images A and C).