Saudi Board of Anesthesia SPA, Ministry of Health King Fahad General Hospital, Jeddah, Kingdome of Saudi Arabia.
Anesthesiology Department, College of Medicine and King Abdulaziz University Hospital, Jeddah, Kingdome of Saudi Arabia.
Pain Physician. 2022 Aug;25(5):325-337.
Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local anesthetics (LAs) and steroids, epidural injection, botulinum toxin (BT) injection, and surgery.
To investigate the efficacy of BT, LA, and corticosteroid (CS) injections in relieving pain in patients affected by PS.
This systematic review and meta-analysis was conducted according to the "Cochrane Handbook for Systematic Reviews of Interventions" and the "Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA)" guidelines.
A systematic search was conducted through PubMed, Cochrane, Web of Science, and Scopus through April 2021 for studies investigating the efficacy of BT, LA, or CS injection in improving pain in patients with PS. After screening retrieved studies, data were extracted from included studies and pooled. Overall results were reported as standardized mean difference (SMD) and 95% confidence interval (CI). Analysis was performed using RevMan software version 5.4.
Sixteen studies were included in this systematic review, and 12 of them were included in the quantitative synthesis. The pain scores decreased significantly after treatment with BT (SMD = -2.00; 95% CI [-2.84, -1.16], P < 0.001), LA and CS (SMD = -4.34; 95% CI [-5.77, 2.90], P < 0.001), LA (SMD = -3.73; 95% CI [-6.47, -0.99], P = 0.008), CS (SMD = -2.78; 95% CI [-3.56, -2.00], P < 0.001), and placebo injection (SMD = -0.04; 95% CI [-0.07, -0.01], P = 0.002). BT injection was less effective than LA and CS together (P = 0.006), more effective than placebo (P = 0.001), and similar to LA (P = 0.24) and CS (P = 0.18), when injected alone.
A wide variety of study designs were utilized to obtain the largest sample size available. Many of the included studies lack randomization, and some are retrospective in nature. These limitations may introduce bias into the analyzed data and affect the results. Many studies had a low sample size and are of moderate quality, limiting the generalizability of the results. Also, we could not conduct a direct meta-analysis due to the lack of sufficient double-arm studies comparing different types of injection therapies.
In patients with PS, satisfactory pain improvement can be obtained by BT, LA plus CS, LA, or CS injection therapy. Injection of LA plus CS showed the best efficacy.
梨状肌综合征（PS）是一种由于坐骨神经在梨状肌内受压而引起的疼痛病症。PS 通常是单侧的，主要与坐骨神经受压有关。治疗包括物理治疗、镇痛药、抗炎药、行为改变、局部麻醉剂（LAs）和皮质类固醇（CS）注射、硬膜外注射、肉毒杆菌毒素（BT）注射和手术。
研究 BT、LA 和 CS 注射治疗 PS 患者疼痛的疗效。
本系统评价和荟萃分析根据“Cochrane 干预系统评价手册”和“系统评价和荟萃分析的首选报告项目（PRISMA）”指南进行。
通过 PubMed、Cochrane、Web of Science 和 Scopus 系统检索 2021 年 4 月前关于 BT、LA 或 CS 注射治疗 PS 患者疼痛改善的疗效的研究。筛选检索到的研究后，从纳入的研究中提取数据并进行合并。总体结果以标准化均数差（SMD）和 95%置信区间（CI）报告。分析使用 RevMan 软件版本 5.4 进行。
本系统评价纳入了 16 项研究，其中 12 项研究进行了定量综合分析。BT（SMD=-2.00；95%CI[-2.84，-1.16]，P<0.001）、LA 和 CS（SMD=-4.34；95%CI[-5.77，2.90]，P<0.001）、LA（SMD=-3.73；95%CI[-6.47，-0.99]，P=0.008）、CS（SMD=-2.78；95%CI[-3.56，-2.00]，P<0.001）和安慰剂注射（SMD=-0.04；95%CI[-0.07，-0.01]，P=0.002）治疗后疼痛评分显著降低。BT 注射的疗效不如 LA 和 CS 联合（P=0.006），但优于安慰剂（P=0.001），与 LA（P=0.24）和 CS（P=0.18）单独注射相似。
为获得最大样本量，采用了多种研究设计。许多纳入的研究缺乏随机化，并且有些是回顾性的。这些限制可能会给分析数据带来偏差并影响结果。许多研究样本量小，质量中等，限制了结果的普遍性。此外，由于缺乏比较不同类型注射疗法的双臂研究，我们无法进行直接的荟萃分析。
在 PS 患者中，BT、LA+CS、LA 或 CS 注射治疗可获得满意的疼痛改善。LA+CS 注射效果最好。
