Impact of Sciatic Blocks on Ambulatory Status and Length of Stay: A 2-Center Case-Control Study

Sciatica is a common complaint in the emergency department (ED). Point-of-care ultrasound-guided nerve block (USNB) techniques, such as transgluteal sciatic nerve blocks or hydrodissections have shown effectiveness in improving pain. However, ambulatory status, not necessarily pain, is what dictates patients’ need for hospital admission or observation. In this setting, we compare USNB to traditional treatment.

This was a retrospective review of patients age ≥18 years treated at two EDs from October 1, 2022 to August 31, 2025 with suspected sciatica based on ICD-10 codes. Patients who received a USNB were matched with traditional, non-USNB treatment in a 1:2 ratio for age, sex, presence of diabetes, and BMI. Patients with recent spinal surgery, bilateral extremity pain, cord impingement symptoms, or dementia were excluded. Outcomes included ambulatory status and ED (LOS) in minutes (min), treatment-related complications, need for admission and return to the ED within one week of discharge. Bivariate analyses were conducted to determine whether differences existed between groups, with Mann Whitney U testing for continuous variables and Fisher’s exact testing for discrete variables.

There were 161 total cases analyzed: 59 received USNB and 102 received traditional treatment. In the USNB group, 18 (30.5%) could not ambulate on ED arrival, and 6 (10.17%) still were not able to ambulate at ED disposition. Only 5 (4.9%) patients in the traditional group were unable to ambulate on ED arrival, which increased to 14 (13.73%) on ED disposition. This change in ambulatory status trended towards statistical significance (p<0.001), but our population was ultimately underpowered (power = 0.35). LOS was shorter for the traditional care group compared with the USNB group (traditional: median 204 min [132–302]; USNB: median 300 min [205–450], p < 0.001). Initial pain scores, hospital admission rates, and unplanned return visits did not differ between the two groups. Use of traditional medications was also similar.

Although we saw a trend towards improved ambulatory status with USNB compared with traditional treatment, our study was underpowered to make actionable conclusions. Patients receiving USNB had longer ED LOS than the traditional treatment group. Future aims should focus on direct correlations between USNB and disposition.