resident nyu New york city, New York, United States
Case Diagnosis: L4-5 Radiculopathy
Case Description: A 29-year-old man with a history of lumbar disc herniations presented with acute on chronic lower back pain with radiation down his right posterior leg. He reported 10/10 pain with attempted movement. On physical exam, he had a positive straight leg raise test with inability to ambulate more than a few steps without any focal deficits.
He received NSAIDs, acetaminophen, muscle relaxants, a lidocaine patch, diazepam, and morphine without improvement in his pain score or ability to ambulate. He was then offered and consented for a transgluteal sciatic nerve block (TGSNB). Fifteen minutes after the TGSNB was performed, he reported 0/10 pain and was ambulating without discomfort. The patient was followed up at the 12, 24, and 36 hours mark to reassess patient pain level and functional status. At each time interval, the patient endorsed 0/10 pain, ability to conduct daily activities, and adverse effects were absent.
Discussions: Lower back pain (LBP) constitutes one of the most common causes of pain and disability worldwide. A significant percentage of people with LBP have radicular symptoms consistent with sciatica. TGSNB has been used by regional anesthesiologist for both acute and chronic pain. Oftentimes, these acute on chronic exacerbations are related to spasm of the muscle. The TGSNB can provide relief of symptoms for the duration of the acute phase of pain. Foot drop remains one of the few documented adverse effects of the TGSNB but was not observed in this case.
Conclusions: The TGSNB provides a safe and effective option in treating acute sciatica pain. It can provide immediate symptom relief and augment ability to tolerate physical therapy.
