A lumbar piriformis block is a minimally invasive injection procedure that manages severe sciatic pain and other symptoms caused by piriformis syndrome. This syndrome causes the piriformis muscle, which is located deep in the buttocks behind the gluteus maximus, to become irritated, causing muscle spasms and sciatic pain. Sciatica is characterized as pain, numbness, and tingling along the back of the leg and foot. Lumbar piriformis blocks contain a local anesthetic and corticosteroids, which help decrease inflammation and discomfort in the piriformis muscle and surrounding nerves. The purpose of a lumbar piriformis block is to minimize pain, increase function, and enable progress in physical therapy. Patients may require a series of injections to ensure the best possible outcomes.
A lumbar piriformis block is performed with local anesthesia and under fluoroscopy or ultrasound guidance. During the procedure, the patient is placed in a prone position with the area above the sacrum and greater trochanter exposed. The skin is thoroughly sanitized and marked before an Orthopedic and Wellness physician administers a local anesthetic into the surgical sites. For patients undergoing a fluoroscopic-guided piriformis block, a contrast dye may be injected into the affected tissues before the actual injection to help ensure proper needle placement. During an ultrasound-guided piriformis block, an ultrasound probe is used to help physicians insert the needle into the lateral third of the piriformis muscle. Once the needle placement is confirmed, the physician will administer the therapeutic piriformis block. After the anesthetic and pain relieving medication have been injected, the needle will be removed and the surgical site will be bandaged. Patients are then sent to a separate room to recover.
Because IV sedation isn’t generally used during a piriformis block, patients can return home shortly after the procedure. Some patients may experience temporary leg weakness and numbness from the local anesthetic, so a neurologic evaluation may be required before the patient can drive home. While complications after a piriformis block are rare, they can still happen. The pain management specialists at Orthopedic and Wellness encourage patients to call the office immediately if they begin to experience the following symptoms or side effects: infection or abscess near the injection site, bleeding, fever, hematoma formation at the injection site, or severe sciatic neuropathy.