A Novel Approach: Ultrasound-Guided Transgluteal Sciatic Nerve Block Using D5W and Bupivacaine/Dexamethasone for...

Acute sciatica can cause severe radicular pain that is often unresponsive to systemic medications in the emergency department (ED). Ultrasound-guided transgluteal sciatic nerve blocks offer a targeted, opioid-sparing method of pain.

We present a case of a patient with intractable bilateral lower extremity pain secondary to sciatica, successfully treated with transgluteal nerve blocks under ultrasound guidance. The sciatic nerves were visualized in the gluteal region between the greater trochanter and ischial tuberosity. One side was anesthetized using dextrose 5% in water (D5W), and the other with a combination of bupivacaine and dexamethasone. The patient reported significant pain relief within 20 min and was safely discharged with outpatient follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the expanding role of regional anesthesia techniques in ED pain management and highlights a unique instance of bilateral nerve blocks producing effective analgesia despite the use of D5W alone on one side.