Needle Manipulation Techniques

The safe placement and manipulation of needles and other instruments in interventional pain management settings require advanced tactile skills, comprehensive knowledge of anatomy, and expertise with fluoroscopy. Prior to beginning an interventional pain management procedure, it is incumbent on the injectionist to assure that the setting is appropriate for efficiency and patient safety. Setting up the room, orienting the fluoroscopy, and positioning the patient are crucial for appropriate needle placement. Visualizing the target, carefully choosing the skin insertion point, and advancing the needle in small increments to the target will facilitate procedure success. The art of safely and accurately placing the needles into the body and directing them to suspected pain generating targets takes time to develop and can be aided by this chapter’s focus on pre-injection setup, techniques for needle placement and advancement, the use of fluoroscopy, and injection of contrast medium and active medication.