Coccygeal Nerve Injection & Manipulation of Coccyx

Painful sacrum -  Image courtesy of yodiyim at FreeDigitalPhotos.netWhat is a Coccygeal Nerve Injection? 

  • The coccygeal nerve is situated over the coccyx (tailbone).
  • A coccygeal nerve injection involves the injection of local anaesthetic and steroid onto the coccygeal nerve. This is performed to treat coccygeal pain (i.e. coccydynia - tailbone pain).
  • This procedure is performed in conjunction with manipulation of the coccyx (tailbone) under sedation.
  • This procedure is always performed using X-ray guidance in the day surgery setting.


Prior to the Procedure

  • All blood thinning products (except aspirin) must be stopped prior to your procedure. You will be advised by letter when to stop taking these medications at the time that your admission date is arranged.
  • You are able to take your other regular medications with a sip of water on the morning of your procedure.
  • If you are an insulin dependent diabetic you will always be at the beginning of the list. Please bring your insulin with you and it will be given to you following your procedure.
  • Hamilton Day Surgery Centre staff will advise you of your fasting and admission times.
  • You must not have anything to eat, drink, smoke or chew prior to your procedure.
  • You will need to organise someone to drive you home after the procedure as you will not be able to drive for 24 hours after your procedure.


What Will Happen? 

  1. You will be admitted to the day surgery by a nurse and you will be asked to change into a gown.
  2. The Anaesthetist will speak with you and place a cannula (plastic needle) into a vein on your hand. 
  3. In the procedure room, you will be assisted to position on the procedure table lying on your abdomen with a pillow under your hips and abdomen.
  4. The Anaesthetist will administer some sedation drugs into your vein.
  5. An X-ray machine will be used to determine where the Doctor will place the needle for your procedure.
  6. Once you are sedated, your coccyx will be gently manipulated.
    • The procedure will take around 10 minutes.
  7. Steroid and local anaesthetic will be injected once correct placement has been established with use of x-ray contrast (Omnipaque).
  8. After the block, you will be placed on a trolley and taken to recovery, where you will remain for around one hour.
  9. After having something to eat and drink, you will be discharged with a carer.


Post Procedure

  • Gentle activity and rest is recommended in the first 24 hours following the procedure. You may then return to normal activity.
  • The local anaesthetic will wear off approximately 12 – 18 hours following your procedure.
  • The steroid will take 48 hours to start working.
    • During this time there may be a window of increased pain or discomfort.
  • Following your manipulation you may have increased pain for a few days.
  • A nurse from HPC will telephone you 24 - 48 hours following your procedure to check on your progress and organise a follow-up appointment.
  • The steroid will remain effective for 1 – 6 months, depending on amount of irritation or inflammation present.

If you require further explanation of the procedure, please contact Hunter Pain Clinic nursing staff on (02) 4985 1800.


* Image courtesy of yodiyim at