Abstract

Background: Piriformis syndrome, a condition that affects predominantly females, leads to significant morbidity and impacts the quality of life. Despite its prevalence, it remains underdiagnosed, especially in the developed world. Treatment options include physiotherapy, painkillers, massage, heat, corticosteroids, local anesthetics, and botulinum toxin. However, comparative analysis of combination therapy versus botulinum toxin alone is limited.
Objective: To compare the efficacy of intravenous steroids combined with bupivacaine versus botulinum toxin (Botox) injections in the treatment of piriformis syndrome.
Methods: This quasi-experimental study was conducted at the Department of Anesthesiology, Combined Military Hospital, from January 2022 to December 2022, following ethical approval. The study included 100 patients diagnosed with piriformis syndrome, divided into two groups: Group L (n=50) received 10 ml of 0.25% bupivacaine with 40 mg of methylprednisolone, and Group B (n=50) received 100 U of botulinum toxin type A diluted in 10 ml distilled water. Standard monitoring was applied, and injections were performed under ultrasound guidance with the patients in the prone position. Pain scores were assessed using the Visual Analog Scale (VAS) at 24 hours, 72 hours, 7 days, and 28 days post-procedure. Patient satisfaction was measured using a 5-point Likert scale at 28 days. Data were analyzed using t-tests and chi-square tests, with significance set at p<0.05.
Results: The mean age was 36 ± 3.35 years in Group L and 35.82 ± 3.42 years in Group B (p=0.297). The mean weight was 75.82 ± 5.23 kg in Group L and 77.64 ± 4.47 kg in Group B (p=0.066). Before the procedure, both groups had a median VAS pain score of 7.0. At 24 hours, the median pain score was 4.0 in Group L and 5.0 in Group B (p=0.292). At 72 hours, Group L had a median pain score of 3.0 compared to 4.0 in Group B (p=0.010). At 7 days, the scores were 2.0 and 3.0 respectively (p=0.013), and at 28 days, they were 2.0 and 3.0 respectively (p=0.013). The median satisfaction score at 28 days was 1.0 in Group L and 2.0 in Group B (p=0.043).
Conclusion: Combination therapy with local anesthetics and steroids is superior to botulinum toxin in reducing pain and improving patient satisfaction in piriformis syndrome. This approach should be considered the first-choice treatment.