Genicular Nerve Research Articles

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis based on trial data

BackgroundFor patients with painful knee osteoarthritis, long-term symptomatic relief may improve quality of life. Cooled radiofrequency ablation (CRFA) has demonstrated significant improvements in pain, physical function and health-related quality of life compared with conservative therapy with intra-articular steroid (IAS) injections. This study aimed to establish the cost-effectiveness of CRFA compared with IAS for managing moderate to severe osteoarthritis-related knee pain, from the US Medicare system perspective.MethodsWe conducted a cost-effectiveness analysis utilizing efficacy data (Oxford Knee Scores) from a randomized, crossover trial on CRFA (NCT02343003), which compared CRFA with IAS out to 6 and 12 months, and with IAS patients who subsequently crossed over to receive CRFA after 6 months. Outcomes included health benefits (quality-adjusted life-years [QALYs]), costs and cost-effectiveness (expressed as cost per QALY gained). QALYs were estimated by mapping Oxford Knee Scores to the EQ-5D generic utility measure using a validated algorithm. Secondary analyses explored differences in the settings of care and procedures used in-trial versus real-world clinical practice.ResultsCRFA resulted in an incremental QALY gain of 0.091 at an incremental cost of $1711, equating to a cost of US$18,773 per QALY gained over a 6-month time horizon versus IAS. Over a 12-month time horizon, the incremental QALY gain was 0.229 at the same incremental cost, equating to a cost of US$7462 per QALY gained versus IAS. Real-world cost assumptions resulted in modest increases in the cost per QALY gained to a maximum of US$21,166 and US$8296 at 6 and 12 months, respectively. Sensitivity analyses demonstrated that findings were robust to variations in efficacy and cost parameters.ConclusionsCRFA is a highly cost-effective treatment option for patients with osteoarthritis-related knee pain, compared with the US$100,000/QALY threshold typically used in the US.

Evaluation of the iPACK block injectate spread: a cadaveric study

Background and objectivesUltrasound-guided infiltration of the interspace between the popliteal artery and capsule of the knee (iPACK) block, a new regional analgesic technique, is believed to relieve posterior knee pain,...

Phenol Neurolysis of Genicular Nerves for Chronic Knee Pain

Phenol Neurolysis of Genicular Nerves for Chronic Knee Pain

A Novel Technical Protocol for Improved Capture of the Genicular Nerves by Radiofrequency Ablation.

Fluoroscopically guided cooled genicular nerve radiofrequency ablation (RFA) is an increasingly performed procedure for chronic, refractory knee pain due to osteoarthritis. Traditionally, partial sensory denervation has been accomplished through ablation of the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies have demonstrated additional sensory nerves and significant anatomic variation that impact current protocols. We describe an updated cooled genicular nerve radiofrequency ablation protocol that accounts for varied nerve location of the superomedial, superolateral, and inferomedial genicular nerves, as well as capture of the terminal articular branches of the nerves to the vastus intermedius, vastus lateralis, and vastus medialis. Furthermore, we describe an adjusted technique for inferomedial genicular nerve capture that mitigates the risk of pes anserine tendon injury. Technical report and brief literature review. Cadaveric studies relating to the sensory innervation of the anterior knee joint were reviewed, and a more accurate and comprehensive cooled genicular nerve radiofrequency ablation (CRFA) protocol is proposed. Based on recent, rigorous anatomic dissections of the knee, the proposed genicular nerve CRFA protocol will provide more complete sensory denervation and potentially improve clinical outcomes. Prospective studies will be needed to confirm the hypothesis that this protocol will result in improved effectiveness and safety of genicular nerve RFA.

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Background and objectivesRefractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain....

Effectiveness of Genicular Nerve Cooled Radiofrequency Ablation on Chronic Knee Osteoarthritis Pain

Background: Outside of an invasive total knee arthroplasty, the available therapies for the treatment of pain secondary to knee osteoarthritis (OA) provide marginal and short-lived symptomatic relief. Genicular nerve radiofrequency ablation (RFA) serves as an alternative treatment modality for OA-associated knee pain and disability. Objectives: To quantify the effectiveness of cooled radiofrequency ablation (C-RFA) of the genicular nerves for chronic knee pain secondary to OA. Study Design: Retrospective chart review performed using Redcap, implementing current procedural terminology codes. Setting: An academic pain management center. Methods: Study population included patients treated with C-RFA from April 2015 through June 2017. Numeric Rating Scale (NRS) data were analyzed at 3 time points: 2 weeks, 4-6 weeks, and 7-33 weeks post-RFA (extended follow-up). Primary outcome for statistical analysis was NRS and the change in NRS from baseline at each of the 3 predetermined time points. Differences between the change in NRS and the number of diagnostic blocks performed (1 vs. 2) was evaluated. Correlation between the change in NRS and patient body mass index (BMI) was calculated. Results: Pre-RFA average NRS scores were available for 47 knees from 31 individuals, which were included in the analysis. The mean NRS score decreased by 50% at 2 weeks (n = 33; P < 0.001), 55% at 4-6 weeks (n = 18; P < 0.001), and 26% at 7-33 weeks (n = 18; P = 0.009). Eight patients (12 knees) provided specific data on the total duration of relief following RFA. The mean duration was 39 weeks or approximately 9 months. There were no statistically significant differences between groups receiving 1 versus 2 diagnostic blocks at 2 weeks or 4-6 weeks post- RFA. At 7-33 weeks, those who received 1 block had a decrease in NRS of –3.1, whereas those who received 2 blocks had an increase in NRS of +0.1 (P = 0.008). There was no correlation identified between BMI and change in NRS at any time point. Limitations: This study’s retrospective design inherently leads to a higher risk of selection bias. The sample size was relatively small as a high percentage of patients were lost to follow-up. The primary outcome measure for this study was the change in mean NRS pain score, and the mean of ordinal data with a nonnormal distribution lacks validity in statistical analysis. Conclusions: In this study population, C-RFA of the genicular nerves lead to 50% or greater pain relief at 2 weeks and 4-6 weeks postintervention. A 26% pain relief was achieved at 7-33 weeks, but this did not meet the established minimal clinically important difference cutoff. Two diagnostic genicular nerve blocks did not improve the rate of treatment success when compared to a single diagnostic block. BMI does not appear to correlate with outcomes. Key words: Genicular radiofrequency ablation, genicular RFA, cooled radiofrequency ablation, chronic knee pain, knee osteoarthritis

Indications of the Neurotomy of Genicular Nerves by Radiofrequency for the Treatment of Knee Osteoarthritis: A Literature Review.

Osteoarthritis (OA) is one of the most frequent and incapacitating pathologies today, especially of the knee. Among the possible approaches for knee OA, the neurotomy of the genicular nerves by radiofrequency (RF) has been gaining prominence. However, as this is a relatively new procedure, indications for its implementation are still unclear. The objective of the present review is to identify the main indications of the use of RF for the treatment of knee OA in the medical literature. A review of the literature was performed in January 2018 through a search in the PubMed, ClinicalKey and Google Scholar databases. After reviewing the main articles on the subject, it was concluded that the main indications of the use of RF for the treatment of knee OA were: OA Kellgren-Lawrence grades 3 and 4, with moderate to severe pain and failure of conservative treatment, mainly in elderly people; persistence of pain even after total knee arthroplasty (TKA); patients with an indication for TKA who refuse to undergo surgical treatment.

Valoración de la efectividad y seguridad de dos técnicas de radiofrecuencia para el tratamiento de la gonalgia secundaria a gonartrosis. Estudio prospectivo randomizado doble ciego

Background and objectiveIn patients with knee pain due to gonarthrosis, we have treatments that are not free of side effects. Objectiveto evaluate the analgesic efficacy of radiofrequency (pulsed and conventional) on the saphenous nerve at the subsartorial level and the genicular nerves of the knee, by ultrasonography. Materials and methodsProspective, randomized, double-blind clinical trial. G1 (RDF1): subjects subjected to radiofrequency, G2 (PLCB): subjects subjected to placebo. A decrease ≥30% of the pain was considered clinically relevant, according to numerical rating scale and in the Western Ontario and McMaster Universities Osteoarthritis Index, global patient impression questionnaire (PGIC) and health status questionnaire (SF-12) in the evaluation at month, three months and six months after the completion of the technique. Results28 patients (G1: 12, G2: 16), 72% women, age: 75.2±9.1 years, body mass index: 29.9±4.64. The analysis did not show a pain reduction, neither statistically significant, not clinically relevant, at one month, three, or six months with respect to the start of treatment, in the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire and numerical rating scale (rest, movement). Regarding PGIC and the SF-12 questionnaire, there were no statistically significant differences between G1 and G2 either before or after treatment. ConclusionsThe combination of two radiofrequency techniques, does not cause a reduction in the intensity of the knee pain, at month, three, or at six months after its completion. It is necessary to change the radiofrequency technique and include more variables to continue with the efficacy study.

Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How.

Genicular nerve radiofrequency ablation (GNRFA), including conventional, cooled, and pulsed techniques, has been used in the management of symptomatic knee osteoarthritis (OA). This new and innovative treatment option has the capacity to decrease pain and improve function and quality of life in certain patients. GNRFA is reserved for patients with symptomatic knee OA who have had failure of conservative treatment and have had failure of or are poor candidates for surgery. GNRFA has been shown to consistently provide short-term (3 to 6-month), and sometimes longer, pain relief in patients. GNRFA has been demonstrated to be safe to administer repeatedly in patients who respond well to this minimally invasive procedure. GNRFA is a 2-step procedure. First, patients are given a diagnostic block under fluoroscopy or ultrasound guidance. Specifically, 1 mL of lidocaine is injected using a 20-gauge, 3.5-in (8.9-cm) spinal needle around the superior lateral, superior medial, and inferior medial genicular nerve branches. The diagnostic block is extra-articular. If the patient reports a ≥50% reduction in baseline pain for a minimum of 24 hours following the injection, then the patient is a candidate for genicular ablation. The osseous landmarks for the diagnostic block are exactly the same as for the ablation procedure. Both procedures are well tolerated in the office setting under local skin anesthesia or can be done in the operating room under conscious sedation using a low-dose sedative such as midazolam for anxious patients. General anesthesia is not required for GNRFA. This procedure is most commonly performed by interventional pain specialists but may also be performed by any physician with appropriate training. In some jurisdictions, physician assistants and nurse practitioners may perform this procedure subject to their supervision requirements. Conservative treatment for symptomatic knee OA includes weight loss management, physical and aquatic therapy, bracing, lateral wedge insoles, transcutaneous nerve stimulation, nonsteroidal anti-inflammatory drugs in combination with a proton pump inhibitor, autologous blood-based therapies, and cortisone and hyaluronic acid injections1,2. Surgical treatment for symptomatic knee OA includes knee arthroscopy, high tibial osteotomy, total knee replacement, and unicompartmental knee replacement in patients without lateral compartment disease2. It should be noted that there is some evidence suggesting that steroid injection, viscosupplements, and arthroscopy are not effective for the management of knee OA. Thermal GNRFA differs from all other treatment alternatives because this procedure causes denaturing of the 3 sensory nerves primarily responsible for transmitting knee pain from an arthritic joint to the central nervous system. In this procedure, heating occurs from an intense alternating electrical field at the tip of the cannula, which produces sufficient heat to denature the proteins in the target tissue. The accepted heating parameters for this procedure are 70° to 80°C for 60 or 90 seconds. A commonly raised question is whether this procedure precipitates a Charcot-type joint. The Charcot joint involves much more than reduced innervation; it occurs in the context of chronically compromised vascularity and altered soft-tissue characteristics as well as peripheral neuropathy. Moreover, a Charcot-type joint does not develop because the deafferentation of the weight-bearing joint is partial3. To our knowledge, no Charcot-type joints have been reported after this procedure. Conversely, data from an animal study have shown that selective joint denervation may lead to the progression of knee OA4. The ablation procedure is done outside the knee joint, unlike alternatives such as intra-articular therapies and surgery. The effectiveness of nonsurgical knee OA interventions in alleviating pain and improving joint function is generally inadequate1. However, GNRFA appears to be an emerging alternative for patients who have had failure of conservative and surgical treatments. It is not uncommon in our clinical practice for patients to achieve adequate pain control following ablation for up to 1 year. GNRFA provides temporary relief from symptomatic knee OA because it does not eliminate the potential for peripheral nerve regrowth and regeneration, and thus pain, to return.

Gonartroz Hastalarında Ultrason Eşliğinde Uygulanan Geniküler Sinir Pulsed Radyofrekans Tedavisinin Ağrı ve Diz Fonksiyonlarına Uzun Dönem Etkisi

Objective : Osteoarthritis of the knee is the most common musculoskeletal disease in older adults which causes chronic knee pain. Pulsed radiofrequency (PRF) on genicular nerves (GN) has become increasingly popular in the treatment of chronic knee pain due to its long duration of action and non-destructive therapy. This study aimed to reveal the effects of ultrasound-guided PRF therapy on GN in patients with knee osteoarthritis (KOA). Materials and Methods: This study included patients, who were diagnosed with gonarthrosis grade 3 to 4 according to the Kellgren-Lawrence classification which patients suffered from intractable knee pain, at least for six months despite conservative treatment. The ultrasound-guided PRF on GN (GPRF) was performed in those patients with a reduction of 50% or more visual analog scale (VAS) score after the diagnostic GN block (GNB). VAS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated before, and 1, 3, 6 and 12 months after the procedure. Results: Of the 293 patients included in the criteria, ultrasound-guided GPRF was administered to 232 patients who responded to GNB. While the mean VAS score of the patients before the GPRF was 6.77 ± 1.24, the mean VAS scores at the 1st, 3rd, 6th and 12th months of the GPRF were 2.76 ± 1.14, 2.94 ± 1.08, 3.53 ± 0.64, and 4.58 ± 0.75, respectively. The mean WOMAC score of the patients before GPRF was 65.75 ± 14.15, while the mean WOMAC score of the 1st, 3rd, 6th and 12th months after GPRF was 36.14 ± 13, 36.52 ± 11.06, 37.88 ± 10.86, and 41.67 ± 10.84, respectively. Conclusion: Ultrasound-guided GPRF therapy in chronic knee pain which does not respond to conservative treatments reduces pain for at least 12 months and is effective improving knee functions.

The Efficacy of Ultrasound-Guided Pulsed Radiofrequency of Genicular Nerves in the Treatment of Chronic Knee Pain Due to Severe Degenerative Disease or Previous Total Knee Arthroplasty.

BackgroundPulsed radiofrequency of genicular nerves in the management of osteoarthritis related chronic knee pain has recently become a promising treatment. Ultrasonography has replaced fluoroscopic guidance in pain medicine. The aim of this study was to investigate the effect of ultrasound-guided genicular pulsed radiofrequency on knee pain and function in patients who had severe knee osteoarthritis or who had previous knee arthroplasty.Material/MethodsThe retrospective study included a total of 23 patients with chronic knee pain, of which 17 patients were included in Group I (non-operated), and 6 patients were included in Group II (post-arthroplasty). Treatment was based on ultrasound-guided pulsed radiofrequency of the superior medial, superior lateral, and inferior medial genicular nerves. The Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before treatment, and at 3 weeks and at 3 months following the procedure.ResultsPulsed radiofrequency of the genicular nerves significantly reduced perceived pain and disability in the majority of the patients. The proportion of the patients with improvement of ≥50% in pretreatment VAS scores at 3 weeks and 3 months following treatment were 14 out of 17 patients (82%) and 15 out of 17 patients (88%) in Group 1, and 4 out of 6 patients (67%), 4 out of 6 patients (67%) in Group 2, respectively.ConclusionsOur study results suggest that ultrasound-guided pulsed radiofrequency of genicular nerves is a safe and minimally invasive procedure that significantly alleviates pain and disability in patients with severe degenerative disease or with previous knee arthroplasty.

A Prospective Randomized Comparison of the Efficacy of Ultrasound- vs FluoroscopyGuided Genicular Nerve Block for Chronic Knee Osteoarthritis

Background: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopyguided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. Objectives: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. Study Design: This research used a prospective randomized comparison design. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated preprocedure, and 1 and 3 months after genicular nerve block. Results: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasoundguided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. Limitations: We were unable to perform double-blind randomization and did not evaluate patients’ baseline emotional states. Conclusions: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance. The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim’s MS thesis at the University of Ulsan College of Medicine (2018). Key words: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index

03:18 PM Abstract No. 298 Safety and efficacy of image-guided radiofrequency ablation of the genicular nerve for pain management in patients with moderate to severe osteoarthritis of the knee: an initial single-institution experience

To analyze the safety and efficacy of image-guided genicular nerve radiofrequency ablation (RFA) for the treatment of pain in non-surgical candidates with moderate to severe knee osteoarthritis (OA). In an IRB-approved prospective study, consecutive patients with pain from moderate to severe knee OA refractory to anti-inflammatory analgesia and multiple intraarticular lidocaine-steroid injections who underwent radiofrequency ablation of genicular nerves were included. All patients initially underwent anesthetic blocks of the superior medial and lateral and inferior medial genicular nerve branches and experienced great short-term pain relief of >6 points out a 10 scale. Radiofrequency ablation of the same nerve branches were performed 1-2 weeks after nerve block. Follow up at 1 month after the procedure was done to asses for any procedure related complications such as bleeding or infection. Efficacy of the treatment was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess overall symptoms, stiffness, pain, and functional daily living pre block/ablation and at 3 months post treatment. A total of ten knees were treated in 8 patients. The average age of the patients was 70.9 years. Mean follow-up time was 3.5 months. No procedure related complication was identified. The mean total WOMAC score (out of 100) improved significantly from baseline score of 47 to 65.9 at 3 months post treatment (p=0.019). Subanalysis of the overall symptoms component of the WOMAC questionnaire demonstrated significant decrease in mean overall symptoms score from 11.4 to 7.3 (p=0.046). Mean stiffness score decreased from 6.2 to 3.5 (p=0.003) and mean pain score decreased from 22.5 to 13.3 (p=0.026). There was also significant improvement in the functional daily living limitations with mean baseline score of 30.2 and 3 month post therapy score of 20.3 (p=0.037). Imaged-guided radiofrequency ablation of genicular nerves is a safe treatment option with good short-term outcome in patients that do not qualify for TKA because of comorbidities with moderate to severe OA of the knee refractory to conservation treatments.

Radiofrequency of genicular nerves to relieve osteoarthritis knee pain

Radiofrequency of genicular nerves to relieve osteoarthritis knee pain

Reduced Opioid Use After Surgeon-Administered Genicular Nerve Block for Anterior Cruciate Ligament Reconstruction in Adults and Adolescents.

Pain management after anterior cruciate ligament reconstruction (ACLR) may pose arisk of prolonged opioid use. The purposes of this study in ACLR were to investigate the efficacy of a surgeon-administered local-regional block of specific genicular nerves on post-operative analgesia following ACLR and to quantify the outpatient opioid consumption and duration through the complete post-operative course. Prospectively, all patients undergoing primary ACLR by a single surgeon were studied over a 10-month period. Exclusion criteria consisted of history of pre-operative opioid use, revision surgery, multi-ligament surgery, allergy to oral opioids, and allergy to local anesthetic. ACLR was performed using autograft or allograft patellar tendon bone (PTB) graft under general anesthesia. At the conclusion of the procedure, all patients received a local anesthetic (bupivacaine 0.25%) injection by the surgeon including a unique circumferential genicular nerve and fat pad block performed based on anatomic landmarks without use of image guidance. Post-operatively, the quantity and duration of opioid use (hydrocodone 5mg) and pain scores were recorded for 4months prospectively. Statistical analysis was performed to evaluate risk factors for increased opioid use. A single surgeon performed 75 ACLRs. After exclusions, a total of 70 patients were enrolled and followed prospectively. None were lost to follow-up. Total opioid consumption ranged from 0 to 30 tablets. The average number of opioid tablets used over the 4-month post-operative course was 5.5 (± 6.7). After surgery, 84% of patients took between 0 and 10 tablets and 21% of patients took no opioids throughout their entire post-operative course. The average duration of consumption was 2.6days (± 3.1). No patients were taking opioids at the 6-week or 4-month follow-up. There were no refills required. No statistically significant differences were seen in regard to graft choice of autograft PTB (n = 48) vs allograft PTB (n = 22) in total opioid consumption or duration of use. In comparing adolescent (n = 31) versus adult (n = 39), no significant difference was seen in total opioid consumption or duration of use. All patients were satisfied with the post-operative pain management protocol. Opioid use was unexpectedly low among patients undergoing ACLR after a surgeon-administered circumferential genicular nerve block and fat pad infiltration. With this protocol, the graft choice and patient age did not correlate with increased opioid use. These results could be useful in guiding post-operative opioid prescribing after ACLR.

Fluoroscopy -guided genicular nerves pulsed radiofrequency for chronic knee pain treatment

The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects. This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12. This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients' pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients. Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

The Antinociceptive Effect of Genicular Nerves Block Compared to Intra-Articular Dexamethasone in Grade III or IV Knee Osteoarthritis

Introduction: Knee pain secondary to osteoarthritis is a common pathology reflecting on the capacity of undertaking daily activities. Among non-surgical procedures, intra-articular corticosteroids represent an alternative complementary therapy. However, blocking the genicular nerves is a recently described technique, easily applied for clinical management. Objectives: To compare efficacy of both intra-articular corticosteroid and genicular block for chronic knee pain. Methods: 20 patients with osteoarthritis were evaluated for: 1) the intensity of pain; 2) the quality of sleep; 3) the capacity to undertake daily activities. Two groups were formed randomly, the first submitted to intra-articular blocking and the second to blocking the genicular nerves. A solution of plane 90 mg lidocaine 1%, and dexamethasone 10 mg was standard and used for intervention in both procedures to a final 10-ml volume. After a weekly appraisal for 12 consecutive weeks, the patients were recalled and submitted to another proposed procedure and in this way, all the patients acted as their own control (a “crossover” study design). In the following weeks, as also in the pretest, the intensity of pain, the quality of sleep and the capacity of undertaking daily activities were evaluated. Results: Both the intra-articular block and the genicular nerves block resulted equally in important reduction of pain during 11 weeks, with similar improvement in the quality of night sleep, and in the capacity of daily activities (p < 0.05). Conclusions: The blocking of the genicular nerves was a safe alternative, minimally invasive and highly efficient, similar to the intra-articular corticosteroid.

Radiofrequency ablation of genicular nerve in a patient with knee pain associated with osteoarthritis

Osteoarthritis is a leading cause of pain and disability in the elderly. In addition to the economic burden, the pain caused by knee osteoarthritis may also reduce the quality of life and affect the patient's psychological condition. Surgery is the best option for patients with severe osteoarthritis. However, a patient with severe osteoarthritis generally tend to be elderly and have multiple co-morbidities, and thus, may not be a suitable candidate for surgery. In regards to several interventional methods that have been investigated, radiofrequency ablation (RFA) neurotomy showed promising results. We report a case of 65-year-old woman with chronic knee osteoarthritis pain that underwent a conventional RFA procedure for right genicular nerve

Use of 0.5 mL and 1.0 mL of Local Anesthetic for Genicular Nerve Blocks.

Use of 0.5 mL and 1.0 mL of Local Anesthetic for Genicular Nerve Blocks.

An Alternative Way to Relieve Neuropathic Pain After Total Knee Replacement by Genicular Nerve Radio-Frequency Ablation

An Alternative Way to Relieve Neuropathic Pain After Total Knee Replacement by Genicular Nerve Radio-Frequency Ablation