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

Area of Science:

• Neurosurgery
• Pain Management
• Nerve Injury Treatment

Background:

• Sciatic nerve injection injury is a common cause of severe, intractable radicular pain.
• Nerve damage from injections is both mechanical and chemical, leading to extensive adhesions and fiber damage.
• Traditional surgical neurolysis, performed under general anesthesia, has limitations in assessing efficacy during the procedure.

Purpose of the Study:

• To evaluate the efficacy and feasibility of an "awake sciatic neurolysis technique" for managing sciatic nerve injection injuries.
• To overcome the limitations of incomplete neurolysis and persistent pain associated with traditional methods.

Main Methods:

• A prospective, nonrandomized study involving 11 patients with sciatic nerve injection injury.
• Patients underwent awake sciatic neurolysis, with real-time feedback on pain levels during rest and leg movement.
• The procedure was terminated when the Visual Analog Scale (VAS) score decreased to 3 or less.

Main Results:

• The average baseline VAS score was 9.5, with 7 out of 10 patients scoring 10.
• During surgery, VAS scores decreased to 3 or below in all but 2 patients.
• Long-term follow-up showed only one patient with a VAS score above 3.

Conclusions:

• Awake sciatic neurolysis is a novel technique for managing sciatic nerve injection injuries with satisfactory outcomes.
• The technique allows intraoperative assessment of neurolysis impact, enabling modifications for improved pain relief.
• While effective, the procedure presents some technical challenges that require further refinement.