Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA.
Department of Emergency Medicine, Kaiser Permanente San Diego, 4647 Zion Ave, San Diego, CA 92120, USA.
Am J Emerg Med. 2023 Jul;69:219.e3-219.e6. doi: 10.1016/j.ajem.2023.02.026. Epub 2023 Feb 28.
Radicular pain due to sciatica is a common occurrence with a lifetime incidence of up to 40%. Typical approaches to treatment vary and may include topical and oral analgesics, such as opioids, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs); however, these medications may be contraindicated in some or result in untoward effects in others. The use of ultrasound-guided regional anesthesia is an important component of multimodal analgesia in the emergency department. Transgluteal sciatic nerve block has been described as an effective method to treat patients with sciatica but carries risk of injury and falls due to its resultant loss of motor function and potential for systemic toxicity when higher volumes are used. Ultrasound-guided peripheral nerve hydrodissection with D5W has been shown to be an effective treatment of various compressive neuropathies in the outpatient setting. Here we present 4 cases of patients who presented to the emergency department with severe acute sciatica and were treated successfully using an ultrasound guided transgluteal sciatic nerve hydrodissection (TSNH). This technique may offer a safe and effective approach to treating patients with sciatica, but more studies are needed to assess its utility on a larger scale.
由于坐骨神经痛引起的神经根痛是一种常见的病症，其终身发病率高达 40%。典型的治疗方法多种多样，可能包括局部和口服镇痛药，如阿片类药物、对乙酰氨基酚和非甾体抗炎药（NSAIDs）；然而，这些药物在某些情况下可能会被禁忌，或者在其他情况下会产生不良反应。超声引导下区域麻醉的使用是急诊科多模式镇痛的重要组成部分。经臀肌坐骨神经阻滞已被描述为治疗坐骨神经痛的有效方法，但由于其导致的运动功能丧失和使用较高容量时可能出现全身毒性，存在受伤和跌倒的风险。超声引导下 D5W 周围神经水分离术已被证明是治疗门诊各种压迫性神经病的有效方法。在这里，我们介绍了 4 例因严重急性坐骨神经痛就诊于急诊科的患者，他们成功地接受了超声引导下经臀肌坐骨神经水分离术（TSNH）治疗。该技术可能为治疗坐骨神经痛患者提供一种安全有效的方法，但需要更多的研究来评估其在更大规模上的效用。
