Which techniques are used for the administration of piriformis injection?

Updated: Feb 28, 2019
  • Author: Mary Louise Caire, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

There are three main techniques commonly used for piriformis injection, differentiated according to the modality employed for localization, as follows:

  • Injection under fluoroscopic guidance
  • Injection under ultrasonographic guidance
  • Injection under electromyographic (EMG) guidance

Computed tomography (CT) is rarely used to guide piriformis injection because it exposes the patient to unnecessary radiation. If a fluoroscope is not available, CT may be used as a substitute; the technique is essentially the same as with fluoroscopy.

In any of the techniques described below, 100 U of onabotulinumtoxinA may be infiltrated instead of the combination of triamcinolone with bupivacaine or ropivacaine. A 50 U/mL dilution with preservative-free normal saline is recommended.


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