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A Randomized Comparison of the Efficacy of 2 Techniques for Piriformis Muscle Injection: Ultrasound-Guided Versus Nerve Stimulator With Fluoroscopic Guidance
  1. Ian M. Fowler, MD, LCDR, MC, USN*,
  2. Anthony A. Tucker, MD, CDR, MC, USN,
  3. Brian P. Weimerskirch, MD, LT, MC, USN,
  4. Thomas J. Moran, DO and
  5. Robert J. Mendez, DO, CAPT, MC, USN
  1. *Department of Anesthesia and Pain Medicine, Naval Medical Center, San Diego, CA
  2. Department of Anesthesia and Pain Medicine, Naval Medical Center, Portsmouth, VA
  1. Address correspondence to: Ian M. Fowler, MD, LCDR, MC, USN, Department of Anesthesia and Pain Medicine, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134 (e-mail: ian.fowler{at}med.navy.mil).

Abstract

Background Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques.

Methods A randomized, comparative trial was carried out to compare the 2 techniques. Twenty-eight patients with a diagnosis of piriformis syndrome, based on history and physical examination, who had failed conservative treatment were enrolled in the study. Patients were randomized to receive the injection either via US or fluoroscopy. Injections consisted of 10 mL of 1% lidocaine with 80 mg of triamcinalone. The primary outcome measure was numeric pain score, and secondary outcome measures included functional status as measured by the Multidimensional Pain Inventory, patient satisfaction as measured by the Patient Global Impression of Change scale, and procedure timing characteristics. Outcome data were measured preprocedure, immediately postprocedure, and 1 to 2 weeks and 3 months postprocedure.

Results We found no statistically significant differences in numeric pain scores, patient satisfaction, procedure timing characteristics, or most functional outcomes when comparing the 2 techniques. Statistically significant differences between the 2 techniques were found with respect to the outcome measures of household chores and outdoor work.

Conclusions Ultrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.

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Footnotes

  • The authors declare no conflict of interest.

    Supported by the Naval Medical Center, Portsmouth, VA.

    Presented at the American Society of Regional Anesthesia and Pain Medicine 11th Annual Pain Medicine Conference, November 2012.

    All authors are military service members. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

    The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the United States Government, Department of the Navy, or Department of Defense.

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