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20 Basic Concerns for Injection Same as in the sections on trigger point and piriformis injections Contraindications Same as in the previous sections Preoperative Considerations Same as in the previous sections Equipment Sterile prep and drape 1.5-in 22- or 25-gauge needle (hyperechoic) 1.5-in 25-gauge needle for infiltration 2 3 mL syringes (for infiltration and local anesthetic injection) Extension tubing (flush air out) Local anesthetic Botulinum toxin (optional) Ultrasonography with 10 to 12 MHz probe Ultrasound gel 4 4 in gauze Medications Choice of long or short acting local anesthetic 2 to 3 mL (0.25% bupivacaine) Botulinum toxin 20 (12-15 units per muscle) Sedation if needed for procedure (midazolam) Techniques The injections can be done blindly, which is not recommended, until fluoroscopy (to see spread of contrast within the muscle), under CT guidance, or with ultrasound which is the preferred technique

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