The goal of this clinical trial is to compare transgluteal sciatic nerve block to standard of care to treat sciatic back pain in adult patients who present to the emergency department.

The main question it aims to answer is: Is a transgluteal sciatic nerve block better than standard of care in improving pain in ER patients with sciatic back pain?

If there is a comparison group: Researchers will compare patients who receive transgluteal sciatic nerve blocks to patients who receive standard of care to see if pain scores improve in ER patients with sciatic back pain.

Participants will be randomized into the transgluteal sciatic nerve block group or the control group (standard of care). Participants will be asked to answer questions about their pain and will be asked to walk a timed short distance.

Inclusion Criteria:

• Adults aged 18 years and older
• Presentation to ED with:
• Acute or acute-on-chronic pain consistent with sciatica, defined as unilateral lumbosacral radicular pain radiating from the lower back or gluteal region to the posterior leg, may extend distal to the knee.
• Pain score ≥ 5/10 on Numeric Rating Scale (NRS)

Exclusion Criteria:

• Known allergy to study medications (e.g., local anesthetics)
• Coagulopathy or current anticoagulation therapy
• Suspected or confirmed spinal infection, or tumor
• Neurological deficits (bowel or bladder dysfunction, leg weakness)
• Inability to provide informed consent