Ultrasound-guided genicular nerve block versus alcoholic neurolysis for treatment of advanced knee osteoarthritis patients

Abstract

Aim of the workTo investigate the clinical efficacy of ultrasound (US)-guided genicular nerve block (GNB) with adjuvant corticosteroid versus alcoholic neurolysis on pain and function of knee osteoarthritis (KOA) patients. Patients and methodsThis study involved 46 advanced KOA patients divided into two groups; group 1 was treated with US-guided GNB with 1 ml triamcinolone + 6 ml bupivacaine divided into the superior medial (SM), superior lateral (SL) and inferior medial (IM) genicular nerves and group 2 was treated with US-guided genicular nerve ablation with 0.5–0.75 ml solution containing 50% alcohol in 0.25% bupivacaine for each nerve. Patients were assessed before and after 1 and 6 months from the injection using visual analogue scale (VAS), numerical rating scale (NRS) for knee pain on walking and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. ResultsPatients mean age was 57.15 ± 3.74 years, disease duration 9.5 ± 1.81, body mass index (BMI) was 35.46 ± 4.44 and were 27 females and 19 males (F:M 1.4:1). The age, disease duration, BMI and gender distribution were comparable between the two groups. VAS, NRS and WOMAC scores improved significantly after injection in group 2 up to 6 months while in group 1 improved for only 1 month. Adverse effects did not persist beyond two weeks and included local pain, hypoesthesia, swelling and bruise. ConclusionsGenicular nerve ablation with alcohol offers a new and seemingly safe modality to treat KOA and improves pain intensity and physical functioning with less cost, less logistic support and avoiding possible corticosteroids adverse effects.