Utilizing an ultrasound-guided nerve block for management of sciatica in the ED: A national simulation-based cost savings analysis

Abstract

Objectives: Acute sciatica is a frequent cause of emergency department (ED) visits and hospital admissions. We evaluated the potential national cost savings of using ultrasound-guided transgluteal sciatic nerve block (TGSNB) in patients with acute sciatica who would otherwise be admitted.

Methods: We performed a Monte Carlo simulation with 10,000 iterations to compare the costs of usual care versus TGSNB targeted to patients who would otherwise require admission. Model inputs included national ED visits for acute sciatica, pre-block admission rates, admission costs, and procedural costs. The primary outcomes were per-patient savings among admitted patients and projected annual national savings.

Results: Targeted use of TGSNB in admission-eligible patients yielded mean per-patient savings of $11,974 (95 % UI: $6702-$18,527). Extrapolated nationally, this corresponds to $45.8 M (95 % UI $22.9 M-$74.0 M) in annual savings. Block costs were modest ($0.67 M (95 % UI: $0.46 M-$0.93 M)), and sensitivity analysis identified admission rates and costs as the main drivers of savings.

Conclusions: Adoption of TGSNB for severe sciatica in the ED may reduce admissions and generate meaningful healthcare savings. Prospective studies are needed to confirm clinical efficacy and implementation feasibility.

Keywords: Cost-effectiveness; Emergency department; Monte Carlo simulation; Regional anesthesia; Sciatica; Transgluteal sciatic nerve block; Ultrasound-guided nerve block.