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Elsawy AGS, Ameer AH, Gazar YA, Allam AES, Chan SM, Chen SY, Hou JD, Tai YT, Lin JA, Galluccio F, Nada DW, Esmat A. Efficacy of Ultrasound-Guided Injection of Botulinum Toxin, Ozone, and Lidocaine in Piriformis Syndrome. Healthcare (Basel) 2022; 11:healthcare11010095. [PMID: 36611554 PMCID: PMC9818865 DOI: 10.3390/healthcare11010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.
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Affiliation(s)
- Ahmed Gamal Salah Elsawy
- Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Abdulnasir Hussin Ameer
- Clinical Neurophysiology, Department of Physiology, College of Medicine, Baghdad University, Baghdad 61224, Iraq
| | - Yasser A. Gazar
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Abdallah El-Sayed Allam
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- MoMaRC Morphological Madrid Research Center, Ultra Dissection Group, 28029 Madrid, Spain
- Interventional Clinical Neurophysiology Fellowship, Baghdad, Ministry of Health, Baghdad 61224, Iraq
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Se-Yi Chen
- Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung 40201, Taiwan
| | - Jin-De Hou
- Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yu-Ting Tai
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
| | - Jui-An Lin
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence:
| | - Felice Galluccio
- MoMaRC Morphological Madrid Research Center, Ultra Dissection Group, 28029 Madrid, Spain
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Rheumatology & Rehabilitation, Fisiotech Lab Studio, 50136 Firenze, Italy
| | - Doaa Waseem Nada
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ahmed Esmat
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
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