(I-621) Is There A Role For Sciatic And Peroneal Peripheral Nerve Blocks In The Acute Management Of Discogenic Sciatica: A Systematic Review And Meta-Analysis
Teaching Assistant King Abdulaziz University Montreal, Quebec, Canada
Introduction: Sciatica is a frequent cause for presentation to the emergency room. Its management is difficult and often involves administration of opioids as part of multimodal analgesic regimens. This is particularly challenging in patients who are not opioid naive. Numerous analgesia strategies are being investigated in an effort to provide more effective pain relief while sparing opioids. In this work, we systematically review the literature on a counterintuitive strategy of targeting the sciatic nerve or its branches with peripheral nerve blocks in patients with discogenic sciatica. This offers the advantage of point of care administration in the emergency room while having a very favorable safety profile.
Methods: Systematic review of PubMed, EMBASE and Google Scholar.
Results: Our search identified 715 abstracts. After applying selection criteria, six case series and one randomized trial studies recruiting 243 patients were retained. Patient ages ranged between 17 years and 69 years. 167 patients were male, and the vast majority had L5 or S1 radiculopathy. All but one had a sciatic, popliteal or tibial nerve blocks. All patients eventually had substantial pain relief after their nerve infiltrations, with effects lasting an average 4.334 +/-1.3 days. The blocks initially failed in 35 patients (14%) necessitating repeat attempts that were ultimately successful. One patient developed an abscess at the injection site. None required admission and all blocks were delivered in the ambulatory setting either based on landmarks or ultrasound, with no need for opioids, fluoroscopy or operating room resources.
Conclusion : This modality warrants further evaluation as it has the promise of adding a powerful tool to our armamentarium in dealing with this challenging population. This may help us minimize resource utilization and opioid consumption. Other adjuncts need to be investigated for back pain in these patients.
