• Ian M Fowler, Anthony A Tucker, Brian P Weimerskirch, Thomas J Moran, and Robert J Mendez.
• From the *Department of Anesthesia and Pain Medicine, Naval Medical Center, San Diego, CA; and †Department of Anesthesia and Pain Medicine, Naval Medical Center, Portsmouth, VA.
• Reg Anesth Pain Med. 2014 Mar 1;39(2):126-32.

BackgroundPiriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques.MethodsA randomized, comparative trial was carried out to compare the 2 techniques. Twenty-eight patients with a diagnosis of piriformis syndrome, based on history and physical examination, who had failed conservative treatment were enrolled in the study. Patients were randomized to receive the injection either via US or fluoroscopy. Injections consisted of 10 mL of 1% lidocaine with 80 mg of triamcinalone. The primary outcome measure was numeric pain score, and secondary outcome measures included functional status as measured by the Multidimensional Pain Inventory, patient satisfaction as measured by the Patient Global Impression of Change scale, and procedure timing characteristics. Outcome data were measured preprocedure, immediately postprocedure, and 1 to 2 weeks and 3 months postprocedure.ResultsWe found no statistically significant differences in numeric pain scores, patient satisfaction, procedure timing characteristics, or most functional outcomes when comparing the 2 techniques. Statistically significant differences between the 2 techniques were found with respect to the outcome measures of household chores and outdoor work.ConclusionsUltrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.

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