Repeated peroneal nerve blocks can remarkably control sciatica leg pains in most cases and avoid the necessity of surgery
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It has been known for some time that peroneal block can also block sciatica:
It’s application required weekly use and this was accomplished in a large study published in an obscure journal and ignored by fact journal is not accessible ( I had to buy a copy of the article).
Prolapsed intervertebral disc with sciatica: the role of common peroneal nerve block
S S Sangwan, MS DNB, Rajeev Mittal, MS, Z S Kundu, MS DNB, R C Siwach, MS DNB, Soneet Aggarwal, MS and R K Garg, MS
Trop Doct 1 July 2005 vol. 35 no. 3 172-174 abstract here
Procedure:
One technique is quite simple – go 2 – 2.5 cm below fibular head, go straight down 1 cm through skin onto fibula, wait for paresthesias and inject 5 mls local.
I grip fibula, go down 2-2.5 cm from fibular joint, inject transversely from side, 5 mls of 2% lidocaine.
- 210 cases of L5 or S1 Radiculitis
- 35/210 needed 2 blocks to show effect
- Pain decreased from 2.99/4 to 0.91/4 – painkiller use was down by 2nd week
- Straight leg raising went from average 32 degrees before to 60 degrees after
- They felt: “A large number of cases, which would otherwise need surgery, could be easily managed by the use of a simple common peroneal nerve block”
Comment – have used it and found it surprisingly helpful where lower leg pain was involved. In sciatica, this leg pain came be very intense and this can relieve it for 3-7 days – whereapon one re-injects. Got to admit this is a lot cheaper then enbrel shots for sciatic pain. I am not sure this would work for cases where pain just referred to buttock.
Dear Admin:
I am Dr.Viken Yeretzian anesthesiologist and pain therapist,a member in the IASP .
I,m very happy to read from your experience in such cases and I will try it because it is more simple than giving epidural injections .
Regards,
Viken
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Is that what a peroneal block is? Just lidocaine injected into that area. I have the pain from my low back down my left leg. There is a disk buldge between l4/5 l5/s1 with a herniation on the l5/s1 buldge … Can this block / injection be done in my back. I’ve had an epidural of cortisone that didn’t work but the lidocaine they injected b4 felt ABSOULTLY AMAZING. I considered perposing to that nurse lol. Any information would help. Also if u have any info on Epiduroscopy good+bad that would be appreciated . Thanks in advance and I understand without my chart it’s impossible to tell… But anything helps
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Sometimes steroid epidurals don’t work because they were injected on the wrong side of an epidural septum:
Epidural Primarily Work on Side Needle Tip is Closer To
http://painmuse.org/?p=591
Results can be doubled if subject lies down with bad side down for at least 20 minutes after:
Steroid Epidurals – Why Some Work And Some Not So Well
http://painmuse.org/?p=344
Steroid epidurals can be augmented by enbrel shots every 10 weeks or so:
Etanercept (Enbrel) for Radiculitis (Sciatica)
http://painmuse.org/?p=52
There are enbrel failures and I discuss other options here:
Enbrel Failure – So What Else Can You Do For Chronic Back Sciatica?
http://painmuse.org/?p=1891
Simple shots through tailbone of just dilute sugar water (D5W) has been tried in what is called a sweet caudal
http://www.orthohealing.com/diagnoses-and-treatments/treatments/sweet-caudal-epidural/
I usually combine D5W with B12 because it has been shown to help diabetics
Clin Ther. 1987;9(2):183-92.
Clinical usefulness of intrathecal injection of methylcobalamin in patients with diabetic neuropathy.
Ide H, Fujiya S, Asanuma Y, Tsuji M, Sakai H, Agishi Y.
http://www.ncbi.nlm.nih.gov/pubmed/3568063
When steroid/enbrel shots wear off, help can be obtained with intrathecal midazolam shots but this is a European idea:
Confirmed – Intrathecal (Spinal) Midazolam Gives 1-3 Months Relief in Chronic and Failed Back Pain
http://painmuse.org/?p=478
The disc is not the only pain generator – the piriformis stands out; I have written about some of these triggers again here:
Enbrel Failure – So What Else Can You Do For Chronic Back Sciatica?
http://painmuse.org/?p=1891
There is a rising awareness that there is a subgroup that tires out very quickly in the back with standing or sitting that might have invovement of some form of instability.
This might respond to prolotherapy which has become popular in orthopedic medicine circles. In Canada, this would be the Canadian Association of Orthopaedic Medicine (CAOM):
http://www.caom.ca/
If you write Charles at their email site, he can tell you what member is close to you.
Hope this helps.
admin