Ultrasound-Guided Subgluteal Sciatic Nerve Perineural Injection: Report on Safety and Efficacy at a Single Institution
Corresponding Author
O. Kenechi Nwawka MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Address correspondence to O. Kenechi Nwawka, MD, Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Third Floor, New York, NY 10021 USA. E-mail: [email protected]Search for more papers by this authorRussell Meyer MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Search for more papers by this authorTheodore T. Miller MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Search for more papers by this authorCorresponding Author
O. Kenechi Nwawka MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Address correspondence to O. Kenechi Nwawka, MD, Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Third Floor, New York, NY 10021 USA. E-mail: [email protected]Search for more papers by this authorRussell Meyer MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Search for more papers by this authorTheodore T. Miller MD
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
Weill Cornell Medical College of Cornell University, New York, New York, USA
Search for more papers by this authorAbstract
Objectives
To determine the safety and efficacy of ultrasound (US)-guided subgluteal sciatic nerve injections.
Methods
A retrospective chart review of US-guided subgluteal sciatic nerve injections at our institution was performed.
Results
Of 221 US-guided subgluteal sciatic nerve injections, 100% achieved technical success, with no postprocedure complications. Sixty-eight percent of patients with follow-up reported symptom relief. Most patients with no relief had suboptimal preprocedure screening.
Conclusions
With appropriate screening, our technique of US-guided subgluteal sciatic nerve injection is safe and effective.
References
- 1 Porchet F, Wietlisbach V, Burnand B, Daeppen K, Villemure JG, Vader JP. Relationship between severity of lumbar disc disease and disability scores in sciatica patients. Neurosurgery 2002; 50: 1253–1260.
- 2 Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976) 2008; 33: 2464–2472.
- 3 Ailianou A, Fitsiori A, Syrogiannopoulou A, et al. Review of the principal extra spinal pathologies causing sciatica and new MRI approaches. Br J Radiol 2012; 85: 672–681.
- 4 Ropper AH, Zafonte RD. Sciatica. N Engl J Med 2015; 372: 1240–1248.
- 5 Yoshimoto M, Kawaguchi S, Takebayashi T, et al. Diagnostic features of sciatica without lumbar nerve root compression. J Spinal Disord Tech 2009; 22: 328–333.
- 6 Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am 1999; 81: 941–949.
- 7 Jankovic D, Peng P, van Zundert A. Brief review: piriformis syndrome—etiology, diagnosis, and management. Can J Anaesth 2013; 60: 1003–1012.
- 8 Stewart JD. The piriformis syndrome is overdiagnosed. Muscle Nerve 2003; 28: 644–646.
- 9 Guvencer M, Akyer P, Iyem C, Tetik S, Naderi S. Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat 2008; 30: 467–474.
- 10 Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 2014; 36: 273–280.
- 11 Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc 2008; 108: 657–664.
- 12 Michel F, Decavel P, Toussirot E, et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med 2013; 56: 371–383.
- 13 Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 2010; 19: 2095–2109.
- 14 Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep 2015; 14: 41–44.
- 15 Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil 2002; 81: 936–942.
- 16 Knudsen JS, McConkey MO, Brick MJ. Endoscopic sciatic neurolysis. Arthrosc Tech 2015; 4: e353–e358.
- 17 Knudsen JS, Mei-Dan O, Brick MJ. Piriformis syndrome and endoscopic sciatic neurolysis. Sports Med Arthrosc 2016; 24: e1–e7.
- 18 Byrd JW. Disorders of the peritrochanteric and deep gluteal space: new frontiers for arthroscopy. Sports Med Arthrosc 2015; 23: 221–231.
- 19 Filler AG, Haynes J, Jordan SE, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2005; 2: 99–115.
- 20 Lee EY, Margherita AJ, Gierada DS, Narra VR. MRI of piriformis syndrome. AJR Am J Roentgenol 2004; 183: 63–64.
- 21 Rossi P, Cardinali P, Serrao M, Parisi L, Bianco F, De Bac S. Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil 2001; 82: 519–521.
- 22 Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CF, Vieira RL, Zember JS. MR imaging of entrapment neuropathies of the lower extremity, part 1: the pelvis and hip. Radiographics 2010; 30: 983–1000.
- 23 Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology 2007; 106: 992–996.
- 24 Walker KJ, McGrattan K, Aas-Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database Syst Rev 2009; 4: CD006459.
- 25 Hara K, Sakura S, Yokokawa N, Tadenuma S. Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block. Reg Anesth Pain Med 2012; 37: 289–293.
- 26 Karmakar MK, Kwok WH, Ho AM, Tsang K, Chui PT, Gin T. Ultrasound-guided sciatic nerve block: description of a new approach at the subgluteal space. Br J Anaesth 2007; 98: 390–395.
- 27 Yamamoto H, Sakura S, Wada M, Shido A. A prospective, randomized comparison between single- and multiple-injection techniques for ultrasound-guided subgluteal sciatic nerve block. Anesth Analg 2014; 119: 1442–1428.
- 28 Flack S, Anderson C. Ultrasound guided lower extremity blocks. Paediatr Anaesth 2012; 22: 72–80.
- 29 Fingerman M, Benonis JG, Martin G. A practical guide to commonly performed ultrasound-guided peripheral-nerve blocks. Curr Opin Anaesthesiol 2009; 22: 600–607.
- 30 Fritz J, Chhabra A, Wang KC, Carrino JA. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimaging Clin N Am 2014; 24: 211–234.
- 31 Chan VW, Nova H, Abbas S, McCartney CJ, Perlas A, Xu DQ. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology 2006; 104: 309–315A.
- 32 Nwawka OK, Miller TT, Jawetz ST, Saboeiro GR. Ultrasound-guided perineural injection for nerve blockade: does a single-sided injection produce circumferential nerve coverage? J Clin Ultrasound 2016; 44: 465–469.
- 33 Brull R, Macfarlane AJ, Parrington SJ, Koshkin A, Chan VW. Is circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block? A proof-of-concept study. Reg Anesth Pain Med 2011; 36: 266–270.
- 34 Keplinger M, Marhofer P, Marhofer D, et al. Effective local anaesthetic volumes for sciatic nerve blockade: a clinical evaluation of the ED99. Anaesthesia 2015; 70: 585–590.
- 35 Reus M, de Dios Berna J, Vazquez V, Redondo MV, Alonso J. Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve—preliminary results. Eur Radiol 2008; 18: 616–620.