The effectiveness of piriformis injection under fluoroscopy and nerve stimulator guidance with local anaesthetic and steroid for management of piriformis syndrome among manual workers in Eastern India: A prospective interventional study

• Published in: Indian Journal of Pain Vol. 34; no. 3; pp. 183 - 188
• Main Authors: Jatua, Debasish, Sarkar, Biplab, Nandi, Gargi, Bhandari, Baibhav, Karmakar, Prasanta, Goswami, Subrata, Basu, Sagar
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.09.2020; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Bupivacaine; fluoroscopy and nerve stimulator guided injection; local anesthetic; low back pain; piriformis injection; piriformis syndrome; Sciatica; steroid; India; piriformis syndrome; local anesthetic; Fluoroscopy and nerve stimulator guided injection; low back pain; piriformis injection; steroid
• ISSN: 0970-5333
• DOI: 10.4103/ijpn.ijpn_76_20

Background: Piriformis syndrome (PS) is a neuromuscular disorder characterized by compression or irritation of sciatic nerve by the piriformis muscle causing pain, tingling, and numbness in the buttocks and sometimes along the distribution of the sciatic nerve descending down to the leg. Pharmacotherapy and physical-therapy remain the first line of management. Local anesthetic (LA) with steroid injection in piriformis muscle is given if conservative management fails. Nerve stimulator, electromyography, radiological imaging, and various other methods have been used to increase the reliability of injections. In the present study, the efficacy of combined fluoroscopy and nerve stimulator guided piriformis injection with LA and steroid for the management of PS has been re-validated among the manual workers of Eastern India. Subjects and Methods: With ethical permission and informed consent from 35 patients of PS fulfilling the inclusion and exclusion criteria were given piriformis injection with 5 mL of 0.25% bupivacaine and 20 mg methyl prednisolone under guidance of a combination of fluoroscopy and nerve stimulator. Thirty-one patients completed the study. Pain in Numeric Rating Scale and Disability by Ronald Morris Disability Questionnaire were recorded for all patients before the procedure, 1 h, 1 week, 3 weeks, and 12 weeks after the procedure and were statistically analyzed. Results: Pain score and back disability score decreased significantly (P < 0.05) after the injection, and the effect was also sustained up to 12 weeks. Conclusions: Injection of LA along with steroid in piriformis muscle under fluoroscopy and nerve stimulator guidance, followed by physiotherapy, is an effective treatment for PS among manual workers.