Genicular Nerve Research Articles

Complex regional pain syndrome of the knee after conventional radiofrequency ablation of the genicular nerves treated successfully with dorsal root ganglion stimulation: A case report

BackgroundRadiofrequency (RF) treatment of the genicular nerves offers pain relief in patients suffering from chronic knee pain including persistent post‐surgical knee pain (PPSP). We present the first case report of the development of complex regional pain syndrome (CRPS) in a chronic knee pain patient after an RF ablation of the genicular nerves that was successfully treated with dorsal root ganglion (DRG) stimulation.Case PresentationThe patient developed increased pain, sympathetic and dysmorphic changes of the index knee 10 weeks after RF treatment for PPSP. Diagnosis of CRPS type II was made using positive clinical findings and the Budapest diagnostic tool. Laboratory workup and PET‐CT were negative. The patient was refractory to usual care and she was treated successfully with dorsal ganglion root stimulation.ConclusionsComplex regional pain syndrome is a possible complication of RF ablation of the genicular nerves in patients with chronic knee pain, and DRG stimulation may be a treatment option. Physicians should be aware of this complication, especially when patients have a medical history of CRPS.

Ultrasound-guided monopolar versus bipolar radiofrequency ablation for genicular nerves in chronic knee osteoarthritis pain: A randomized controlled study

BackgroundThis study compared between monopolar and bipolar radiofrequency (RF) ablation of the genicular nerves using ultrasound guidance (USG) in chronic knee osteoarthritis pain. Material and methodsThis was a prospective, randomized, double-blind study. Fifty patients with knee osteoarthritis pain were equally randomized to either monopolar or bipolar groups. The primary outcome was visual analogue score (VAS). The secondary outcomes were the proportion of successful responders with a reduction of 50% of VAS score at 12 and 24 weeks, the procedure time and pain and oxford knee score (OKS).VAS and OKS were recorded at 1, 4, 12, 24 weeks after intervention. Any complications were reported. ResultsMean VAS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [4.84 ± 0.62 Vs. 3.56 ± 0.71] and 24 weeks [5.44 ± 0.82 Vs. 3.96 ± 0.79]. The Proportion of successful responders with a reduction of at least 50% of VAS score were more in bipolar group than monopolar group at 12 weeks (80% Vs. 12%) and 24 weeks (44% Vs. 4%). Mean OKS score in bipolar group was (p < 0.05) lower than monopolar group at 12 weeks [26 ± 3 Vs. 34 ± 3] and 24 weeks [27 ± 3 Vs. 35 ± 3].The procedure time and pain were (p < 0.05) lower in monopolar than bipolar group. The complications were similar in both groups. ConclusionUSG bipolar RF ablation is more effective than monopolar RF ablation in controlling knee osteoarthritis pain as for the duration and severity of pain without fluoroscopic confirmation.

Effect of Ultrasound-Guided Genicular Nerve Block in Knee Osteoarthritis with Neuropathic Pain

Introduction: Osteoarthritis(OA) remains one of the most common musculoskeletal disorders. It was thought to be a non-inflammatory, wear and tear disorder, but recent studies have suggested the presence of a neuropathic pain component. Genicular nerve block has emerged as a new intervention to manage the neuropathic component of pain in knee OA. Materials and Methods: We conducted a prospective, hospital-based descriptive interventional study. Persons having OA with neuropathic pain component were identified using PainDETECT scale. We randomised the participants meeting the inclusion criteria into two groups. In the study group with thirty participants, we performed an ultrasound-guided triple-site genicular nerve block. The control group of equal size underwent conservative management. Participants were assessed using PainDETECT scale, Visual analogue scale (VAS) and Western Ontario McMaster Universities Arthritis Index (WOMAC) at baseline, 2 weeks and 4 weeks. Results: In the study group, PainDETECT score decreased from 24.93±1.99 at baseline to 8.07±2.97 at 2weeks and 7.9±2.87 at 4weeks. WOMAC significantly improved in the study group from 94.27±8.35 to 48.43±10.14 at 4weeks. VAS score also decreased in the study group from 9.2±0.71 to 4.73±1.44 at 2weeks and 4.53±1.28 at 4weeks. The control group also showed a significant decrease in PainDETECT score from 24.13±1.17 to 12.07±1.36 at 4weeks. However, a decrease in VAS score(from 9.13±0.68 to 7.67±0.67 at 4weeks) and WOMAC(from 97±4.49 to 88.5±4.93 at 4weeks) was less significant. Conclusion: Genicular nerve block provides significant pain relief and improved functional outcome in OA knee with neuropathic pain component. Furthermore, it is more effective than conservative management.

How I do it: genicular nerve blocks for acute pain

How I do it: genicular nerve blocks for acute pain

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

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.

Effectiveness of the Thermal Genicular Nerve Radiofrequency Ablation Therapy Under Fluoroscopy in Patients with Non-operative Advanced Stage Knee Osteoarthritis: 1-Year Follow-Up Results.

In this study, our aim was to present the 1-year results of the effect of thermal genicular nerve radiofrequency ablation (GNRFA) therapy on pain and functional outcomes in patients with advanced knee osteoarthritis. After retrospectively examining the hospital records, 49 knees of 35 patients who had undergone thermal RFA of the superior medial, superior lateral, and inferior medial branches of the genicular nerve under fluoroscopic guidance between July 2019 and December 2020 were included in the study. The visual analog scale (VAS) scores of the patients were recorded before RFA, on the day of RFA, and at the first, sixth, and 12th months postoperatively, as well as their Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores before RFA and at the 12th month postoperatively. Complications developed after the procedure and during the follow-up period were screened. Twenty-five of the patients were females and 10 males, with a mean age of 77.3 ± 7.9years (range 61-92years). The mean VAS score was 8.4 ± 0.9 before RFA, and as 1.7 ± 1.0 right after the procedure, 2.4 ± 1.7 at the first month, 3.4 ± 1.8 at the sixth month, and 4.4 ± 1.9 at the 12th month (p < 0.01). In terms of the WOMAC score, the average value was 69.7 ± 6.4 before the treatment and 36.1 ± 11.8 at the final follow-up at the 12th month (p < 0.01). No complications were observed in any patient during the treatment or the follow-up period. Non-surgical thermal GNRFA therapy of knee osteoarthritis provides significant outcomes in terms of pain and functionality, with no significant systemic or local side effects. Therefore, the technique can be considered as an alternative to other methods when treating advanced osteoarthritis.

Radiofrequency Ablation for the Knee Joint: A Survey by the American Society of Pain and Neuroscience.

BackgroundGenicular nerve radiofrequency ablation (RFA) is an effective, minimally invasive procedure often used to treat patients with intractable knee pain secondary to knee osteoarthritis and failed knee replacements. The prevalence of knee pain in adults has been estimated to be as high as 40% and is continuously increasing with an aging population. Over the past two decades, proceduralists have adopted variations in patient preparation, procedural steps, and post-operative care for genicular nerve RFA procedures. A survey was dispensed via the American Society of Pain and Neuroscience (ASPN) to gain a popular assessment of common practices for genicular nerve RFA.MethodsA 29 question survey was dispensed via SurveyMonkey to all members of ASPN. Members were able to respond to the survey a single time and were unable to make changes to their responses once the survey was submitted. After responses were compiled, each question was assessed in order to determine common practices for genicular nerve RFA.ResultsA total of 378 proceduralists responded to the survey. There was high consensus with the three most commonly targeted nerves. The inferomedial, superomedial, and superolateral genicular branches were treated by 95–96% of respondents, while other targets were less commonly treated. There remains some debate among proceduralists regarding the need for a second diagnostic nerve block and the type of steroid used for diagnostic nerve blocks.ConclusionPain physicians use a wide variety of methods to perform genicular nerve ablations. The data offered by the survey show that there is no standardized protocol when it comes to treating knee pain via genicular nerve block and ablation and highlights controversies among proceduralists that ought to serve as the targets of future clinical research aimed at establishing a standardized protocol.

Comparison of ultrasound guided pulsed radiofrequency of genicular nerve with local anesthetic and steroid block for management of osteoarthritis knee pain.

BackgroundTo compare ultrasound-guided pulsed radiofrequency (PRF) of the genicular nerve with the genicular nerve block using local anesthetic and steroid for management of osteoarthritis (OA) knee pain.MethodsThirty patients with OA knee were randomly allocated to receive either ultrasound-guided PRF of the genicular nerve (PRF group) or nerve block with bupivacaine and methylprednisolone acetate (local anesthetic steroid [LAS] group). Verbal numeric rating scale (VNRS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were measured at pre-procedure and 1-, 4-, and 12-weeks post-procedure.ResultsVNRS scores decreased significantly (P < 0.001) in both the groups at 12 weeks and other follow up times compared to baseline. Seventy-three percent of patients in the PRF group and 66% in the LAS group achieved effective pain relief (≥ 50% pain reduction) at 12 weeks (P > 0.999). There was also a statistically significant (P < 0.001) improvement in WOMAC scores in both groups at all follow up times. However, there was no intergroup difference in VNRS (P = 0.893) and WOMAC scores (P = 0.983). No complications were reported.ConclusionsBoth ultrasound-guided PRF of the genicular nerve and blocks of genicular nerve with local anesthetic and a steroid provided comparable pain relief without any complications. However, PRF of the genicular nerve is a procedure that takes much more time and equipment than the genicular nerve block.

Genicular Nerve Ablation Review Using Cooled-Radiofrequency Nerve Ablation.

Osteoarthritis (OA) is globally the most prevalent joint disease and causes patients great pain, limited joint mobility, and psychological distress. Short- and long-term therapies like steroid injections and arthroplasty exist, respectively. Joint arthroplasty can effectively treat symptomatic end-stage OA, but most patients do not go through with surgery because they are not qualified, have comorbidities, or do not wish to undergo surgery. As a result, patients can turn to opioid agonists for pain relief, which contributes to the growing opioid epidemic that mars our communities. Cooled radiofrequency ablation (C-RFA) is an effective treatment modality that can alleviate the pain associated with moderate to severe OA, especially in patients who have tried and failed conservative therapy. This review article elucidates the benefits of C-RFA, while also walking through the technical steps to performing the procedure. For patients suffering from debilitating joint OA, especially of the knee, C-RFA is a minimally invasive procedure that ensures pain relief.

Does Application of Genicular Nerve Block in Addition to Intra-articular Steroid Injection Increase Efficacy in Patients with Knee Osteoarthritis?

Does Application of Genicular Nerve Block in Addition to Intra-articular Steroid Injection Increase Efficacy in Patients with Knee Osteoarthritis?

Abstract No. : ABS3055 : Comparative evaluation of radiofrequency ablation of genicular nerve and genicular nerve block in patients with osteoarthritis of the knee

Background and Aims:Osteoarthritis of the knee is the most common form of chronic arthritis. There is a mixture of degradative and reparative processes in the articular cartilage and subchondral bone, associated with osteophyte formation and low grade inflammation.Methods:Patients were divided in two groups of 30 each. In group-I (n=30), patients received fluoroscope guided radiofrequency(RF) ablation of genicular nerve using RF electrode to a temperature of 60°C for 120 seconds. In Group-II (n=30), patients received fluoroscope guided genicular nerve block using 9ml drug solution comprising of 8ml of 0.5% bupivacaine plus 1ml of methylprednisolone (40mg). Pain was assessed using numerical rating scale (NRS).Results:NRS scores were clinically less in group I as compared to group II. There was clinically better patient satisfaction in group I as compared to group II. When Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index was compared in between the two groups, it was statistically comparable at all time intervals throughout the study period (p>0.05Conclusion:Fluoroscope guided radiofrequency ablation of genicular nerve and genicular nerve block with local anaesthetic and steroid are safe and effective techniques for management of symptomatic osteoarthritis of knee. However, fluoroscope guided radiofrequency ablation of genicular nerve is better than fluoroscope guided genicular nerve block in terms of improvement in pain score, physical status and patient satisfaction.

The Analgesic Effect And Functional Improvement Produced by Radio-Frequency Ablation of Genicular Nerves in Patients with Advanced Knee Osteoarthritis

Objective: To study the efficacy of radiofrequency ablation for treating pain in patients with advanced knee osteoarthritis.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Pain Clinic of Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Sep 2019 to Feb 2020.&#x0D; Methodology: Patients of more than 50 years of age, with grade III and IV Kellgren-Lawrence grades of knee osteoarthritis and at least a score of 4 for three months on the numerical rating scale were included in the study. Measurements were taken on the numerical rating scale and Western Ontario and McMaster universities osteoarthritis index before and four weeks after fluoroscopy-guided radiofrequency ablation of three genicular nerves around the knee joint. .&#x0D; Results: Fifty patients (mean age: 62 ± 6.5 years) were included in the study. The median numerical rating scale scores before and after intervention were 9 (Interquartile range: 7-10) and 5 (Interquartile range: 2-8), respectively (p&lt;0.001). The mean Western Ontario and McMaster universities osteoarthritis index scores before and after intervention were 76.7 ± 13.4 and 50.3 ± 18, respectively (p&lt;0.001). No complications were reported. The reduction in numerical rating scale, Western Ontario and McMaster universities osteoarthritis index scores after the intervention were significantly better in females than in males (p=0.023 and p=0.012 respectively); however, no significant change was observed for the right and left knee or grades of knee osteoarthritis (p&gt;0.05).&#x0D; Conclusion: Radiofrequency ablation of genicular nerves around the knee joint significantly improves pain, stiffness and body function in patients with advanced knee osteoarthritis .........................

Pulsed Radiofrequency Rhizotomy of the Genicular Nerves of the Knee Guided by Radioscopy and Ultrasonography: Step-By-Step Technique

Osteoarthritis (OA) of the knee is highly prevalent and causes pain, stiffness, and harms the quality of life of millions of patients. Scientific evidence about radiofrequency ablation or rhizotomy of genicular nerves has been presented with increasing frequency in the literature for the treatment of chronic pain related to knee OA as an alternative to total knee arthroplasty. The main indication for this procedure is symptomatic OA unresponsive to conservative treatment, regardless of the disease evolution, although more common indications are in Kellgren–Lawrence grade III or IV, in post-total knee arthroplasty residual pain without an identified cause, in patients with comorbidities and high surgical risk, and those who do not want to undergo surgery. The aim of this study is to describe the step-by-step rhizotomy technique with pulsed radiofrequency of the 3 genicular nerves, guided by radioscopy and ultrasonography.

Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study.

To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45–70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).

Radiofrequency Ablation in Cooled Monopolar or Conventional Bipolar Modality Yields More Beneficial Short-Term Clinical Outcomes Versus Other Treatments for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

To evaluate various radiofrequency ablation (RFA) treatments for knee osteoarthritis (OA) and determine the best modality, target, number of electrodes, and image guidance for improving knee pain and function. Electronic databases were searched for randomized controlled trials (RCTs) comparing the efficacy of RFA treatments for knee OA from inception up to September 30, 2021. The primary outcome was the visual analog scale (VAS), and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Bayesian network meta-analysis was performed to synthesize the mean difference (MD) and rank the comparative effectiveness of treatments. A total of 21 eligible RCTs (from 2011 to 2021, involving 1,818 patients) with 8 RFA treatments, 6 intra-articular injections, NSAIDS, exercise, and placebo were assessed. Conventional bipolar genicular nerve RFA (GNRFA) had the greatest net benefit on the VAS at 6 months (MD,-5.5; 95% confidence interval [CI],-4.3 to-6.7; SUCRA, .98). And cooled monopolar GNRFA had the greatest net benefit on the WOMAC at 6 months (MD,-33; 95% CI,-37 to-29; SUCRA, .99). In conventional and pulsed modalities, bipolar RFA was associated with a significant decrease in VAS and WOMAC than monopolar RFA. Combining pulsed intra-articular RFA and platelet-rich plasma injection had no additional positive effects on VAS or WOMAC at 3 months. RFA is effective in improving both knee pain and function in patients with OA, at least in the short term (6 months). Patients respond better to the cooled modality than the conventional and pulsed modalities. Bipolar is more effective than monopolar for improving pain and function in conventional and pulsed modalities. Fluoroscopy and ultrasound guidance showed no differences in improving pain and function. The effectiveness of RFA in cooled modality using bipolar or in combination with various intra-articular injections remains to be compared. II, systematic review and meta-analysis of Level I and II studies.

How I Do It: Genicular Nerve Radiofrequency Ablation

How I Do It: Genicular Nerve Radiofrequency Ablation

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

BackgroundThe clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. We conducted a meta-analysis to systematically evaluate the efficacy and safety of RF treatment in patients with knee OA.MethodsSearches of the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases were performed through August 30, 2021. The major outcomes from published randomized controlled trials (RCTs) involving patients with knee OA were compared between RF and control groups, including Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Global Perceived Effect (GPE) scale, and adverse effects at available follow-up times.ResultsFifteen RCTs involving 1009 patients were included in this meta-analysis, and the results demonstrated that RF treatment correlated with improvements in pain relief (VAS/NRS score, all P < 0.001) and knee function (WOMAC, all P < 0.001) at 1–2, 4, 12, and 24 weeks after treatment as well as patients’ degree of satisfaction with treatment effectiveness (GPE scale, 12 weeks, P < 0.001). OKSs did not differ significantly between the two groups. Moreover, treatment with RF did not significantly increase adverse effects. Subgroup analysis of knee pain indicated that the efficacy of RF treatment targeting the genicular nerve was significantly better than intra-articular RF at 12 weeks after treatment (P = 0.03).ConclusionsThis meta-analysis showed that RF is an efficacious and safe treatment for relieving knee pain and improving knee function in patients with knee OA.

Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)&#x0D; Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19.&#x0D; Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.&#x0D;

The Effectiveness of Fluoroscopically-Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review

The Effectiveness of Fluoroscopically-Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review

Comparison between fluoroscopy-guided radiofrequency ablation of genicular nerves and intra-articular injection of steroid in relieving pain and improving function among candidates of knee replacement surgery: A randomized controlled trial

Comparison between fluoroscopy-guided radiofrequency ablation of genicular nerves and intra-articular injection of steroid in relieving pain and improving function among candidates of knee replacement surgery: A randomized controlled trial