Awake Sciatic Nerve Neurolysis after Injection Injury - An Innovative Technique and Our Experience.

Abstract

Background and introduction: Sciatic nerve injection injury is the most common type of injection nerve injury. Injection injury to nerve causes severe, intractable radicular pain in affected limb. Owing to chemical damage, nerve is damaged both mechanically and chemically. As a result, adhesions and nerve fibers damage is more than expected. Surgical neurolysis is recommended for pain relief. However it is done in general anesthesia and effect of neurolysis is checked only after reversal.

Objective: There are chances that incomplete neurolysis can cause persistence of pain. To overcome this limitation, we evaluated "awake sciatic neurolysis technique."

Methods: This was a prospective, nonrandomized study which evaluated awake sciatic neurolysis in sciatic nerve injection injury patients. A total of 11 patients underwent this procedure after evaluating clinical profile. During this procedure, patients were asked about pain relief on rest and leg movement. When VAS score decreased to 3 or less, procedure was stopped.

Results: The average VAS score was 9.5 (10 in 7 cases). During surgery, VAS score decreased to 3 and below in all except in 2 cases. In long-term follow-up, one patient had VAS more than 3.

Conclusion: Our study is about a novel technique "awake sciatic neurolysis." The results were satisfactory, but it has some technical difficulties. It has advantage of checking impact of neurolysis during surgery and modify technique according to relief.