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This is a retrospective review of 26 patients with sciatica due to the piriformis muscle syndrome. Most patients had pain in the buttock area and sciatica, and most experienced difficulty walking and sitting, even for short periods of time. Reproduction of the sciatica upon deep palpation, either by gluteal or rectal route, was diagnostic. Reproduction of sciatica occurred in 92% of the patients upon deep digital palpation and in 100% of the patients upon rectal or pelvic examination. Other signs were helpful but not consistent. After the appropriate diagnosis, the treatment was relatively easy and rewarding. This study emphasizes that the diagnosis of piriformis muscle syndrome is clinical; without the appropriate clinical examination, it can be easily misdiagnosed.

for intravenous regional anesthesia. Anesth Analg 1989;68:328-32. thetic, sensory, and motor blockade when injected into the isolated extremity, unpleasant psychotomimetic effects after the reltwse of the tourniquet limit the usefulness of this use of krtamine. Ketamine cannot be recommended for intravenous regional anesthesia unless these unpleasant side effects are a~o l i s~, e~ or corltroJled by ,neans of pl,armaco~ogic ad;uvnnts.We studied ketamine iritravenous regional anesthesia of the upper extremity in zdunteers using concentrations of 0.5%, 0.3%, and 0.2%. Ketamine 0.5 and 0.3% produced adequate intravenous regional anesthesia. Anesthesia was inadequate when a 0.2% concentration was used. However, although the 0.3% coilcentration provides coniplcte sympo-

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