The effect of popliteal sciatic nerve block with methylprednisolone in the management of postinjection sciatic neuropathy after clinical and electrophysiological examination

The effect of popliteal sciatic nerve block with methylprednisolone in the management of postinjection sciatic neuropathy after clinical and electrophysiological examination

Background/aim: This study aimed to investigate the effects of popliteal sciatic nerve block (PSNB) in the treatment of postinjection sciatic neuropathy (PISN) resistant to conservative treatments. Materials and methods: Patients diagnosed with PISN were included in the study. A damaged branch of the sciatic nerve was detected after neurological and electrophysiologic studies (EPSs). Visual analogue scale (VAS) was administered before, one hour after, and one month after the procedure. Also Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) was administered before and one month after the procedure. The effects of EPSs findings and loss of muscle strength on the VAS and LANSS scores that measured after PSNB were evaluated. Results: PSNB was performed in 17 patients (12 males and 5 females) with a diagnosis of PISN. Their mean age was 54.95 ± 12.55 years, and the mean duration of symptoms was 3.53 ± 1.28 months. The EPS findings revealed a lateral truncus injury in 5, a medial truncus injury in 3, and injury to both in 9 patients. The initial muscle power scale scores were grade 0 in 2, grade 2 in 1, grade 3 in 7, grade 4 in 5, and grade 5 in 2 patients. The initial VAS and LANSS scores were 7.53 ± 1.06 and 17.35 ± 3.12. The mean VAS scores at the first hour and one month after the procedure decreased to 2.53 ± 1.70 and 4.18 ± 1.74 while the mean LANSS score one month after the procedure was reduced to 7.88 ± 5.84. The effects of EPSs findings and loss of muscle strength were found significant (p = 0.001), but the duration of symptoms was not found significant (p = 0.36) on the VAS and LANSS scores that measured after PSNB. Conclusion: The outcome of this research proved the effectiveness of PSNB with methylprednisolone in the management of PISN, especially in patients whose pain was located below the knee. EPSs findings and loss of muscle strength indicated the severity of the nerve damage affect the success of PSNB in pain management, but the length of time that elapsed after the nerve injury did not.Key words: Sciatic neuropathy, postinjection neuropathy, popliteal block

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  • 1. Kline DG, Hudson AR. Selected recent advances in peripheral nerve injury research. Surgical Neurology 1985; 24(4):371-376. doi: 10.1016/0090-3019(85)90293-9
  • 2. Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. Journal of Advenced Nursing 2004; 47(3):287-296. doi: 10.1111/j.1365-2648.2004.03092.x
  • 3. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. Journal of Neurosurgery 1998; 89(1):13-23. doi: 10.3171/ jns.1998.89.1.0013
  • 4. Clark K, Williams PE Jr, Willis W, McGavran WL. 3rd. Injection injury of the sciatic nerve. Clinical Neurosurgery 1970;17:111- 125. doi: 10.1093/neurosurgery/17.cn_suppl_1.111
  • 5. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. Journal of Neurosurgery 1998; 89(1):13-23. doi: 10.3171/ jns.1998.89.1.0013
  • 6. Villarejo FJ, Pascual AM. Injection injury of the sciatic nerve (370 cases). Child’s Nervous System 1993; 9(4):229-232. doi: 10.1007/BF00303575
  • 7. Yuen EC, So YT, Olney RK. The electrophysiologic features of sciatic neuropathy in 100 patients. Muscle and Nerve 1995; 18(4):414-420. doi: 10.1002/mus.880180408
  • 8. Ramtahal J, Ramlakhan S, Singh K. Sciatic nerve injury following intramuscular injection: a case report and review of the literature. Journal of Neuroscience Nursing 2006; 38(4):238-240. doi: 10.1097/01376517-200608000-00006
  • 9. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983 ;17(1):45-56. doi: 10.1016/0304- 3959(83)90126-4
  • 10. Yucel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. Journal of Pain 2004 ;5(8):427-432. doi: 10.1016/j.jpain.2004.07.001
  • 11. Geuna S, Raimondo S, Ronchi G, Di Scipio F, Tos P et al. Chapter 3: Histology of the peripheral nerve and changes occurring during nerve regeneration. International Review of Neurobiology 2009;87:27-46. doi: 10.1016/S0074- 7742(09)87003-7
  • 12. Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Research International 2014; 698256. doi: 10.1155/2014/698256
  • 13. Dubovy P, Jancalek R, Kubek T. Role of inflammation and cytokines in peripheral nerve regeneration. International Review of Neurobiology 2013;108:173-206. doi: 10.1016/B978- 0-12-410499-0.00007-1
  • 14. Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nature Neuroscience 2007 ;10(11):1361- 1368. doi: 10.1038/nn1992
  • 15. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007 ;132(3):237-251. doi: 10.1016/j.pain.2007.08.033
  • 16. Kingery WS, Castellote JM, Maze M. Methylprednisolone prevents the development of autotomy and neuropathic edema in rats, but has no effect on nociceptive thresholds. Pain 1999; 80(3):555-566. doi: 10.1016/S0304-3959(98)00251-6
  • 17. Markovic M, Crichton K, Read JW, Lam P, Slater HK. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton’s neuroma. Foot and Ankle International 2008 ;29(5):483-487. doi: 10.3113/FAI-2008- 0483
  • 18. Ly-Pen D, Andreu JL, Millan I, de Blas G, Sanchez-Olaso A. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology 2012 ;51(8):1447-1454. doi: 10.1093/rheumatology/kes053
  • 19. Eker HE, Cok OY, Aribogan A. A treatment option for postinjection sciatic neuropathy: transsacral block with methylprednisolone. Pain Physician 2010; 13(5):451-456. PMID: 2085931
  • 20. Şencan S, Cüce İ, Gündüz OH. Use of fluoroscopic-guided transsacral block for the treatment of iatrogenic postinjection sciatic neuropathy: Report of three cases. Turkish Journal of Physical Medicine and Rehabilitation 2019 ;65(4):406-410. doi: 10.5606/tftrd.2019.3077
  • 21. Okonkwo UP, Ibeneme SC, Ihegihu EY, Egwuonwu AV, Ezema IC et al. Effects of transcutaneous electrical nerve stimulation in the Management of PostInjection Sciatic Pain in a nonrandomized controlled clinical trial in Nnewi, Nigeria. BMC Complementary Medicine and Therapies 2018;18(1):310. doi: 10.1186/s12906-018-2373-8
  • 22. Wilson TJ, Kleiber GM, Nunley RM, Mackinnon SE, Spinner RJ. Distal peroneal nerve decompression after sciatic nerve injury secondary to total hip arthroplasty. Journal of Neurosurgery 2018 ;130(1):179-183. doi: 10.3171/2017.8.JNS171260
  • 23. Lee DG, Cho YW, Cho KH, Chang MC. Management of refractory sciatic neuropathic pain using ultrasound-guided pulsed radiofrequency. Journal of Back and Musculoskeletal Rehabilitation 2017 ;30(5):1141-1145. doi: 10.3233/BMR169724
  • 24. Mansoor F. Case definition of traumatic injection neuropathy. Pakistan Journal of Medical Research 2004; 43: 143-149. DOI: 10.4274/npa.5524
  • 25. Korompilias AV, Payatakes AH, Beris AE, Vekris MD, Afendras GD et al. Sciatic and peroneal nerve injuries. Microsurgery 2006; 26(4):288-294. doi: 10.1002/micr.20241
  • 26. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. Journal of Neurosurgery 1998 ; 89(1):13-23. doi: 10.3171/ jns.1998.89.1.0013
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