Dear Pain Matters blog readers,
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Repetitive sciatic nerve blocks may offer substantial pain relief for some patients with nerve pain.
A 50-year-old woman (let’s call her ‘Jane’) suffered ongoing nerve pain in her left lower limb following surgery to remove a schwannoma* on her left S1 nerve root (aka sciatica nerve schwannoma).
Decades earlier aged only 27, Jane suffered ‘electric-like pain’ during intimacy. Shortly afterward, surgery was performed to remove a cyst on her left ovary. Despite surgery and nonsteroidal anti inflammatory drugs (NSAIDs), her pain persisted.
Several years later, a 3 cm surgical incision was performed to remove her left S1 nerve root at the plexus including a schwannoma.
Post-surgery, Jane endured pain upon sitting and touch. She also had a limp in her left leg.
Jane was prescribed NSAIDs, antidepressant and pregabalin. Despite these medications, Jane suffered ongoing mild pain. She also had intense pain at rest and movement as well as severe allodynia upon palpation in the area between S1 to L5 (VAS from 3 to 10).
Jane displayed mild motor weakness during nerve testing of her left lower leg (i.e. during leg abduction, foot eversion, plantar and toes flexion and in the hip extension).
Jane also had drastically reduced sensation in her foot, lower leg and thigh and buttocks.
A sciatic nerve block comprising an anesthetic mixture (20 mL) was injected at the ‘pain trigger point’ (located 1 cm above the midline of the incision).
RESULTS OF SCIATIC NERVE BLOCK
Guess what happened next??
Jane enjoyed immediate pain relief after this sciatic nerve block (VAS 1/10), after suffering years of pain!!
The sciatic nerve block’s pain relieving effects lasted 15 days. Despite her nerve pain returning 15 days later, Jane’s pain had lost its original intensity (VAS decreased to 3/10).
To better manage Jane’s nerve pain, a repetitive sciatic nerve block was prescribed.
Some nerve pain patients may benefit from repetitive sciatic nerve blocks.
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*Usually benign in nature, a schwannoma is a nerve sheath tumour that develop from the Schwann cell.
(1) Naja Z et al. Repetitive nerve block for neuropathic pain management: a case report. Scand J Pain (26 Jan 2018);18(1):125-127.