Disclosures: Jacob L. Ramsey-Morrow, MD: Nothing to disclose

Case Description: Following a motor vehicle accident with subsequent traumatic brain injury, multiple orthopedic injuries, immobility, and spasticity, the patient experienced pain in the sciatic nerve distribution related to the formation of heterotopic ossification in soft tissues around his pelvis. After failing conservative pain management approaches, the patient underwent a sciatic nerve block using the Modified Sim’s position with the patient’s right buttocks exposed; after exposed skin was cleansed and prepped, a 30-gauge 1-inch needle was used to anesthetize the skin and soft tissues overlying the target area with bicarbonated 1% lidocaine. Next, a 22-gauge 3.5-inch spinal needle was advanced using ultrasound guidance until satisfactory needle placement was visualized. After negative aspiration, a combination of 2 mL of triamcinolone 40 mg/mL, 8 mL of lidocaine 1%, and 10 mL of 0.2% ropivocaine was injected.

Setting: Outpatient Musculoskeletal and Interventional Pain Clinic.

Patient: A 30-year-old previously functionally independent male with pain in the sciatic nerve distribution.

Assessment/Results: The patient had significant improvement in his right leg pain after the sciatic nerve block. Approximately 1 month later, he underwent successful resection of right hip heterotopic ossification after it had matured; he subsequently had prophylactic adjuvant radiation of his right hip to prevent recurrent heterotopic ossification.

Discussion: The patient had several predispositions toward developing heterotopic ossification of the hip, including traumatic brain injury, pelvic trauma, spasticity, and immobility. Despite multiple conservative pain management strategies, his pain necessitated a more invasive approach until definitive treatment could be performed once his heterotopic ossification completely matured.

Conclusion: Sciatic nerve blocks can provide adequate pain relief for multiple mechanisms of sciatic nerve entrapment, including heterotopic ossification, in patients who fail more conservative pain management approaches.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sciatic-nerve-block-for-relief-of-pain-related-to-heterotopic-ossification-a-case-report/