A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Demir, Yasin; Güzelküçük, Ümüt; Tezel, Kutay; Aydemir, Koray

doi:10.1093/pm/pnw177

Cited by 25 publications

(31 citation statements)

References 6 publications

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“…In the majority of previous studies, RFA was performed for only 3 genicular nerves, the SMGN, SLGN, and IMGN . Interestingly, the knee joint is supplied by a few other branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves .…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the knee joint is supplied by a few other branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves . So, it is apparent that the previous studies using radiofrequency of 3 genicular nerves might have failed to block the lion's share of nerves supplying the joint . There are a few recent studies in which the nerves supplying the knee were described very well with their anatomical locations .…”

Section: Discussionmentioning

confidence: 99%

“…In most of the earlier studies, the fluoroscopy technique was used, which relies on the perceived anatomical location of the genicular nerves in relation to bone, and it may not be accurate in all instances since there may be variations in the relationship between the bone and the genicular nerve branches . However, in many recent studies, ultrasound was used, and it was observed that nerves can be better visualized using ultrasound and that there is less likelihood of injuring the nerve, which may occur with fluoroscopy . Furthermore, the genicular vessels are in close proximity to the genicular nerves and run the risk for being injured during the procedure .…”

Section: Discussionmentioning

confidence: 99%

“…There has recently been considerable interest in the role of radiofrequency ablation (RFA) of the genicular nerves for knee OA. In the majority of previous studies, ablation was done via a radiofrequency technique using either fluoroscopy or ultrasound for only three genicular nerves, whereas the knee joint is also supplied by a few other nerves . Interestingly, neurolytic agents can also be used to ablate the nerves, and are readily available, less costly, and need less logistic support.…”

Section: Introductionmentioning

confidence: 99%

“…In the majority of previous studies, ablation was done via a radiofrequency technique using either fluoroscopy or ultrasound for only three genicular nerves, whereas the knee joint is also supplied by a few other nerves. [6][7][8][9][10][11] Interestingly, neurolytic agents can also be used to ablate the nerves, and are readily available, less costly, and need less logistic support. There is a recent update in literature about the blockade of seven genicular nerves supplying the knee using ultrasound.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Ultrasound‐Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series

Ahmed

Arora

2018

Pain Practice

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ultrasound‐Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series

Ahmed

Arora

2018

Pain Practice

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Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized Placebo‐Controlled Trial

Shanahan

Robinson

Lyne

et al. 2022

Arthritis & Rheumatology

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Objective This study was undertaken to determine the efficacy of ultrasound‐guided genicular nerve block (GNB) for the management of knee pain in patients with knee osteoarthritis. Methods We performed a 12‐week parallel‐group, placebo‐controlled randomized trial of GNB. Within 2 weeks of randomization, patients with knee osteoarthritis in the active arm received 3 injections of 5.7 mg celestone chronodose (1 ml) and 0.5% bupivacaine (3 ml) to the inferomedial, superomedial, and superolateral genicular nerves; patients with knee osteoarthritis in the placebo arm received injections of normal saline. At baseline and at weeks 2, 4, 8, and 12, patients recorded their pain and disability on a 100‐mm visual analog scale (VAS) (the primary outcome measure), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Intermittent and Constant Osteoarthritis Pain scale. Statistical significance was set at a 2‐sided Type I error of α = 0.0125 for comparisons at each of the 4 time points. We used a global perceived effect scale to measure patient satisfaction. Results The 59 patients (36 female, 23 male) who completed the trial had a mean ± SD age of 68.2 ± 8.6 years. Patients in the active group reported improvements in pain scores at 2, 4, 8, and 12 weeks with a diminution of the effect over time. VAS scores at baseline and at weeks 2, 4, 8, and 12 in the active group (n = 31) versus placebo group (n = 28) were 6.2 versus 5.3 (P = 0.294), 2.7 versus 4.7 (P < 0.001), 3.2 versus 5.1 (P < 0.001), 3.9 versus 4.9 (P < 0.001), and 4.6 versus 5.1 (P = 0.055), respectively. Total WOMAC scores at baseline and at weeks 2, 4, 6, 8, and 12 in the active group versus the placebo group were 54.5 versus 48.1 (P = 0.177), 32.9 versus 44.4 (P < 0.001), 33.7 versus 45.8 (P < 0.001), 39.2 versus 44.8 (P = 0.001), and 42.65 versus 45.1 (P = 0.012), respectively. Conclusion GNB offers short‐term pain relief for knee osteoarthritis.

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Anatomical study of the descending genicular artery and implications for image‐guided interventions for knee pain

Fonkoué¹,

Behets²,

Steyaert³

et al. 2020

Clinical Anatomy

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Introduction The descending genicular artery (DGA) has recently been mentioned as accompanying some nerves in the medial aspect of the knee joint. This could be clinically relevant as the arteries could serve as landmarks for accurate nerve capture during ultrasound‐guided nerve blockade or ablation. The aim of this cadaveric study was to investigate the anatomical distribution of the DGA, assess the nerves running alongside its branches, and discuss the implications for regional anesthesia and knee pain interventions. Methods We dissected the femoral artery (FA) all along its course to identify the origin of the DGA, from which we carefully dissected all branches, in 27 fresh‐frozen human specimens. Simultaneously, we systematically dissected the nerves supplying the medial aspect of the knee from proximally to distally and identified those running alongside the branches of the DGA. The surrounding anatomical landmarks were identified and measurements were recorded. Results The DGA was found in all specimens, arising from the FA 130.5 ± 17.5 mm (mean ± SD) proximally to the knee joint line. Seven distribution patterns of the DGA were observed. We found three consistent branches from the DGA running alongside their corresponding nerves at the level of the medial aspect of the knee: the artery of the superior‐medial genicular nerve, the artery of the infrapatellar branch of the saphenous nerve, and the saphenous branch of the DGA. Conclusion The consistent arteries and surrounding landmarks found in this study could help to improve the capture of the targeted nerves during ultrasound‐guided interventions.

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A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Cited by 25 publications

References 6 publications

Ultrasound‐Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series

Ultrasound‐Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series

Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized Placebo‐Controlled Trial

Anatomical study of the descending genicular artery and implications for image‐guided interventions for knee pain

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