Role of Diagnostic and Therapeutic Nerve Block in Refractory Piriformis Syndrome – A Case Series of 12 Patients

Abstract Piriformis syndrome is characterized by buttock pain, low back pain and when it’s severe it can lead to sensory abnormalities in the lower limbs causing difficulty in walking and thus it has significant impairment of the activities of daily living. Thus, a correct diagnosis and treatment is required to reduce the consequences. The usual treatment is conservative and injections are reserved for refractory cases. The role of piriformis block with ultrasound guidance plus physical therapy needs further enlightenment. We encountered 12 cases who had no improvement in the pain with 6 weeks of oral pharmacological management, so they were given injection triamcinolone 40 mg with lignocaine under ultrasound guidance. Improvement was assessed at immediate post injection period and after 3 months with numerical pain rating scale. 11 of them showed improvement during subsequent follow ups. 1 patient had very little response and was diagnosed with prolapsed intervertebral disc at lumbar level on detailed evaluation. Corticosteroid along with local anesthetic is an effective way of reducing refractory piriformis syndrome pain and ultrasound guidance is more preferred than landmark guidance for its precision and accuracy. Physical therapy further added to recovery by reducing the compressive symptoms.