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

Ahmed, Arif; Arora, Divesh

doi:10.1111/papr.12710

Cited by 18 publications

(15 citation statements)

References 15 publications

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“…The neurolytic effect may be evaluated after 24 to 48 hours, but it may not be evident until 3 to 7 days after the procedure 11 . The duration of the effect varies from 2 months to 2 years in neurolytic blocks 12,14 …”

Section: Discussionmentioning

confidence: 99%

“…However, the needles, thermocouples, radiofrequency generator, and other necessary equipment may not be available or affordable. Chemical neurolysis has been reported in patients with KOA with favorable treatment outcomes 11–13 . Its low cost makes this a viable treatment modality for further investigation.…”

Section: Introductionmentioning

confidence: 99%

“…Its low cost makes this a viable treatment modality for further investigation. Chemical neurolytics such as phenol block pain transmission through Wallerian degeneration of sensory afferent fibers 14 may be ideal for neurolysis of the genicular nerves 12 …”

Section: Introductionmentioning

confidence: 99%

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Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective Study

et al. 2020

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Background Radiofrequency ablation of the genicular nerve is performed for knee osteoarthritis (KOA) when conservative treatment is not effective. Chemical ablation may be an alternative, but its effectiveness and safety have not been examined. The objective of this prospective open‐label cohort study is to evaluate the effectiveness and safety of ultrasound‐guided chemical neurolysis for genicular nerves with phenol to treat patients with chronic pain from KOA. Methods Forty‐three patients with KOA with pain intensity score (Numeric Rating Scale, NRS) ≥ 4, and duration of pain of more than 6 months were considered for enrollment. Ultrasound‐guided diagnostic blocks of genicular nerves (superomedial, inferomedial, and superolateral) with 1.5 mL of 0.25% bupivacaine at each site were performed. Those who reported more than 50% reduction in NRS went on to undergo chemical neurolysis, using 1.5 mL 7% glycerated phenol in each genicular nerve. NRS and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were assessed before intervention and at 2 weeks and 1, 2, 3, and 6 months following the intervention. Results NRS and WOMAC scores improved at all time points. Mean pain intensity improved from 7.2 (95% confidence interval [CI]: 6.8 to 7.7) at baseline to 4.2 (95%CI: 3.5 to 5.0) at 6‐month follow‐up (P < 0.001). Composite WOMAC score improved from 48.7 (95%CI: 43.3 to 54.2) at baseline to 20.7 (95%CI: 16.6 to 24.7) at 6‐month follow‐up (P < 0.001). Adverse events did not persist beyond 1 month and included local pain, hypoesthesia, swelling, and bruise. Conclusion Chemical neurolysis of genicular nerves with phenol provided efficacious analgesia and functional improvement for at least 6 months in most patients with a low incidence of adverse effects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective Study

et al. 2020

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“…However, we believe chemical neurolysis has an added value when compared to RFN, despite the lack of studies related to this technique, and its significance should be investigated further. Chemical neurolysis can be performed with alcohol or phenol and it is cost-effective, easily performed, and has an early clinical outcome [10,11]. Furthermore, it is possible to use this technique as a rescue method in the event RFN fails.…”

Section: Discussionmentioning

confidence: 99%

Alcohol neurolysis of genicular nerve for chronic knee pain

Dass

Kim

et al. 2019

Korean J Pain

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Radiofrequency neurolysis (RFN) of the genicular nerves has recently become accepted as an effective technique to alleviate knee pain particularly in patients with knee osteoarthritis (OA) or postoperative pain. However, genicular nerve RFN can produce high procedure and equipment costs, longer procedural times, procedure-related pain, and failure rate of over 25%. We are presenting two cases of alcohol neurolysis of the genicular nerve using fluoroscopy and ultrasonography in patients with knee OA or persistent postsurgical pain of the knee. Alcohol neurolysis of the genicular nerve with dual imaging modality can be a cheap, safe and effective method in patients with chronic knee pain.

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“…In a case series of four patients with severe OA, the authors report significant improvement in pain and quality of life for longer than 6 months after ultrasound-guided alcohol neurolysis of six genicular nerves. 48 Several nerves contribute to the innervation of the knee through genicular branches. In most subjects, the tibial nerve innervates the anterior knee compartment and its periarticular or intra-articular components are often targeted.…”

Section: Radiofrequency Therapymentioning

confidence: 99%

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

et al. 2018

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Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for patients having persistent, chronic pain following knee surgery. Extracorporeal shockwave therapy is another modality growing in use that may offer short-term symptomatic relief. In this review, we will discuss widely used minimally invasive interventional options for the symptomatic management of osteoarthritic chronic knee pain.

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

Abstract: Ultrasound-guided alcohol neurolysis is a good alternative for patients having severe pain from knee osteoarthritis and provides significant pain relief for more than 6 months.

Cited by 18 publications

References 15 publications

Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective Study

Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective Study

Alcohol neurolysis of genicular nerve for chronic knee pain

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

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