The Efficacy of Ultrasound-Guided Transgluteal Sciatic Nerve Blocks for Sciatic Radiculopathy Pain in the Emergency Department: A Multicenter Prospective Study

Objectives: Pain from acute sciatic radiculopathy (sciatica) can be debilitating, frequently leading to emergency department (ED) presentations. The primary objective of this study was to evaluate the efficacy of transgluteal sciatic nerve blocks (TGSNBs) for ED-based pain control in patients presenting with acute sciatica. Methods: In this prospective, multicenter, observational study, a convenience sample of patients presenting to the ED with acute sciatica were recruited between January 2022 and August 2023. All patients underwent TGSNB. Patients' self-reported pain scores and timed up and go test results were recorded. Pain scores at 24 and 48 hours post-ED disposition were also recorded. Descriptive statistics, Wilcoxon signed rank, and chi(2) tests were utilized for statistical analysis. Results: In total, 63 patients were enrolled. The median pain score was 9 (IQR, 8-10) prior to TGSNB, decreased to 5 (IQR, 3-7; P < .001) post-TGSNB, and remained at 4 (IQR, 2-6.5; P < .001) at approximately 48 hours after disposition. On arrival, 27% (n = 17/63) of patients were unable to ambulate, which decreased to 11% (n = 7/63) post-TGSNB. The proportion of patients who completed the timed up and go test in under 10 seconds significantly increased to 33% (n = 19/63) at ED disposition compared to 1.6% (n = 1/63; P = .003) on presentation. One complication (1.6%, n = 1/63) of a transient foot drop was noted which resolved without further sequelae. Conclusion: Among the specific study population, patients with acute sciatica who elected to have an ultrasound-guided TGSNB in the ED showed significant improvements in pain scores and function. Future studies comparing the efficacy of TGSNB versus standard medical therapy are needed.