Optimizing needle tip visualization during out-of-plane ultrasonography: A novel technique

Ultrasound-guided interventions are rapidly growing area in pain medicine. We developed a novel “underhand” technique aimed to improve upon the “freehand technique”. With the operator's hand stabilization, precise movements of the transducer are easier to perform that can improve visualization of the needle and targeted anatomical structures. Similar to the classical technique hydrolocalization can be used incrementally during the needle advancement to the target structure. Both the wrist up and the wrist down underhand approaches are described and provide the patient and physician comfort with superior needle visualization that can improve injection accuracy. This novel underhand out-of-plane technique may serve as a convenient and precise method to carry out ultrasound-guided interventions when the classical freehand technique may be challenging to perform.