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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

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.

Details

Title
Efficacy of Ultrasound-Guided Injection of Botulinum Toxin, Ozone, and Lidocaine in Piriformis Syndrome
Author
Ahmed Gamal Salah Elsawy 1   VIAFID ORCID Logo  ; Abdulnasir Hussin Ameer 2 ; Gazar, Yasser A 3   VIAFID ORCID Logo  ; Abdallah El-Sayed Allam 4   VIAFID ORCID Logo  ; Shun-Ming Chan 5   VIAFID ORCID Logo  ; Se-Yi, Chen 6 ; Jin-De Hou 7 ; Yu-Ting, Tai 8 ; Jui-An, Lin 9 ; Galluccio, Felice 10   VIAFID ORCID Logo  ; Doaa Waseem Nada 11 ; Ahmed, Esmat 12 

 Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt 
 Clinical Neurophysiology, Department of Physiology, College of Medicine, Baghdad University, Baghdad 61224, Iraq 
 Rheumatology and Rehabilitation Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt 
 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 
 Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan 
 Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung 40201, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung 40201, Taiwan 
 Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan; 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, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan 
 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 
10  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 
11  Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt 
12  Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt 
First page
95
Publication year
2023
Publication date
2023
Publisher
MDPI AG
e-ISSN
22279032
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2761155080
Copyright
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.