Thank you for a very well presented procedure and images. Believe it or not, where I’m working now, we have no fluoro. We have CT and US. Have done these in the past going just under the inferior rim of the coccyx with fluoro as was suggested in another comment. Will give it a go with CT as I feel going through the ligament, as you suggest, is probably more controlled and possibly better tolerated. I wouldn’t feel comfortable using US to get the ganglion as the bone would block visualization. If I just wanted a joint injection at the sc joint, then I could use US… Also, a short block scan of the coccyx region with ct will give me a lot of information about other things that may be going on such as Tarlov cysts, mets, etc.
Labor and Delivery Local anesthetics rapidly cross the placenta and when used for epidural, paracervical, pudendal or caudal block anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity (see CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism ). The potential for toxicity depends upon the procedure performed, the type and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus and neonate involve alterations of the central nervous system, peripheral vascular tone and cardiac function.
8. CPT codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is utilized. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service(UOS). For example:
(1) If a physician injects an anesthetic agent into multiple areas around the sciatic nerve at a single patient encounter, only one UOS of CPT code 64445 (injection, anesthetic agent; sciatic nerve, single) may be reported.
(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.