Medication Summary
The goal of pharmacotherapy is to provide local anesthesia, both superficial and deep, prior and throughout the procedure.
Local Anesthetics
Class Summary
Local anesthetic agents are used to increase patient comfort during the procedure.
Lidocaine (Xylocaine)
Lidocaine is an amide local anesthetic. This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. It is provided by means of local infiltration of 1% lidocaine buffered with sodium bicarbonate.
Bupivacaine (Marcaine, Sensorcaine)
Bupivacaine 0.25% may be used in combination with lidocaine plus epinephrine (50:50 mixture). It decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.
Ropivacaine (Naropin)
Ropivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer postoperative analgesia. The onset is delayed from 5 minutes to about 20 minutes.
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Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient standing.
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Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient reclining.
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Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient reclining.
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Freiberg test. Forceful internal rotation of thigh on affected side elicits pain.
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Beatty maneuver. Patient lies on uninvolved side and abducts involved thigh upward, which elicits pain.
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Fluoroscopy-guided piriformis injection. Anteroposterior fluoroscopic image of piriformis after contrast administration.
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Ultrasound-guided piriformis injection. Greater trochanter and lateral border of sacrum are identified. Ultrasound probe is directed parallel to piriformis. Needle is inserted in lateral third of piriformis.
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Ultrasonogram identifies sciatic nerve, gluteus, and piriformis.
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Fluoroscopy-guided piriformis injection. Greater trochanter and lateral border of sacrum are identified fluoroscopically and used as markers for needle insertion.
