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Ultrasound-guided transgluteal sciatic nerve analgesia for refractory back pain in the ED

      Abstract

      Sciatic radicular back pain is a painful condition resulting in approximately 2% of emergency department (ED) visits a year. Typically, the ED treatment has been limited to various analgesic regimens with limited success sometimes resulting in hospital admissions for pain control. Regional anesthesia has become increasing popular for lower-limb analgesia, but has not universally permeated the ED setting. The transgluteal sciatic nerve block (TGSNB) is a procedure that can provide effective analgesia for lower extremity pain. Herein, we present the first technical description and clinical response to ultrasound-guided TGSNB performed by emergency physicians for acute pain control of sciatic back pain through a series of cases.

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      References

        • Friedman B.W.
        • Chilstrom M.
        • Bijur P.E.
        • Gallaghar E.J.
        Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective.
        Spine (Phila Pa 1976). 2010; 35: E1406-E1411https://doi.org/10.1097/BRS.0b013e3181d952a5
        • Friedman B.W.
        • O’Mahony S.
        • Mulvey L.
        • et al.
        One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain.
        Ann Emerg Med. 2012; 59: 128-133.e3https://doi.org/10.1016/j.annemergmed.2011.09.012
        • Enthoven W.
        • Roelofs P.
        • Deyo R.
        • van Tulder M.W.
        • Koes B.W.
        Non-steroidal anti-inflammatory drugs for chronic low back pain.
        Cochrane Database Syst Rev. 2016; 2 (CD012087. Published 2016 Feb 10)https://doi.org/10.1002/14651858.CD012087
        • Hooten W.M.
        • Cohen S.P.
        Evaluation and treatment of low back pain: a clinically focused review for primary care specialists.
        Mayo Clin Proc. 2015; 90: 1699-1718https://doi.org/10.1016/j.mayocp.2015.10.009
        • Chang A.K.
        • Bijur P.E.
        • Esses D.
        • Barnaby D.P.
        • Baer J.
        Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial.
        JAMA. 2017; 318: 1661-1667https://doi.org/10.1001/jama.2017.16190
        • Friedman B.W.
        • Irizarry E.
        • Solorzano C.
        • et al.
        A randomized, placebo-controlled trial of ibuprofen plus metaxalone, tizanidine, or baclofen for acute low back pain.
        Ann Emerg Med. 2019; 74: 512-520https://doi.org/10.1016/j.annemergmed.2019.02.017
        • Friedman B.W.
        • Irizarry E.
        • Solorzano C.
        • et al.
        Diazepam is no better than placebo when added to naproxen for acute low back pain.
        Ann Emerg Med. 2017; 70: 169-176.e1https://doi.org/10.1016/j.annemergmed.2016.10.002
        • Reavley P.
        • Montgomery A.A.
        • Smith J.E.
        • et al.
        Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department.
        Emerg Med J. 2015; 32: 685-689https://doi.org/10.1136/emermed-2013-203407
        • Foss N.B.
        • Kristensen B.B.
        • Bundgaard M.
        • et al.
        Fascia Iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial.
        Anesthesiology. 2007; 106: 773-778https://doi.org/10.1097/01.anes.0000264764.56544.d2
        • Tran Q.H.
        • Clemente A.
        • Finlayson R.J.
        A review of approaches and techniques for lower extremity nerve blocks.
        Can J Anesth. 2007; 54: 922-934https://doi.org/10.1007/BF03026798
        • Bruhn J.
        • Van Geffen G.J.
        • Gielen M.J.
        • Scheffer G.J.
        Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography.
        Acta Anaesthesiol Scand. 2008; 52: 1298-1302https://doi.org/10.1111/j.1399-6576.2008.01695.x
        • 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: 1442-1448https://doi.org/10.1213/ANE.0000000000000462
        • Nwawka O.K.
        • Meyer R.
        • Miller T.T.
        Ultrasound-guided subgluteal sciatic nerve perineural injection: report on safety and efficacy at a single institution.
        J Ultrasound Med. 2017; 36: 2319-2324https://doi.org/10.1002/jum.14271
        • Brull R.
        • Hadzic A.
        • Reina M.A.
        • Barrington M.J.
        Pathophysiology and etiology of nerve injury following peripheral nerve blockade.
        Reg Anesth Pain Med. 2015; 40: 479-490https://doi.org/10.1097/AAP.0000000000000125
        • Hadzic A.
        • Sala-blanch X.
        • Xu D.
        Ultrasound guidance may reduce but not eliminate complications of peripheral nerve blocks.
        Anesthesiology. 2008; 108: 557-558https://doi.org/10.1097/ALN.0b013e318168efa1
        • Alarasan A.K.
        • Agrawal J.
        • Choudhary B.
        • Melhotra A.
        • Uike S.
        • Mukherji A.
        Effect of dexamethasone in low volume supraclavicular brachial plexus block: a double-blinded randomized clinical study.
        J Anaesthesiol Clin Pharmacol. 2016; 32: 234-239https://doi.org/10.4103/0970-9185.182108
        • Pehora C.
        • Pearson A.M.E.
        • Kaushal A.
        • Crawford M.W.
        • Johnston B.
        Dexamethasone as an adjuvant to peripheral nerve block.
        Cochrane Database Syst Rev. 2017; 11 (2017. Published 2017 Nov 9): CD011770
        • Ribeiro F.S.
        • Bettencourt Pires M.A.
        • da Silva E.X.
        • et al.
        Rethinking sciatica in view of a bilateral anatomical variation of the sciatic nerve, with low origin and high division: historical, anatomical and clinical approach.
        Acta Med Port. 2018; 31: 568-575https://doi.org/10.20344/amp.10567
        • Gosselin S.
        • Hoegberg L.C.G.
        • Hoffman R.S.
        • et al.
        Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning.
        Clin Toxicol (Phila). 2016; 54: 899-923https://doi.org/10.1080/15563650.2016.1214275