Ultrasound-Guided Genicular Nerve Block in Chronic Knee Pain: A Prospective Longitudinal Study
DOI:
https://doi.org/10.25759/spmfr.375Keywords:
Nerve Block, Knee Joint, Osteoarthritis, Knee, Pain ManagementAbstract
Introduction: Chronic knee pain is multifactorial and its management is multimodal, with peripheral nerve blocks being a therapeutic alternative after failure of conservative first-line treatment. our objective was to evaluate the immediate and short-term symptomatic improvement of patients with gonarthrosis submitted to genicular nerve block.
Material and Methods: Twenty blockades of the genicular nerves (ropivacaine and methylprednisolone) were performed, after which questionnaires were carried out to characterize the knee pain in several time frames. The data obtained were processed using IBM-SPSS Software version 24.0.
Results: The 20 patients included in the study (3 men and 17 women) had a median age of 74.5 years, the median pain before the procedure was 9, after was 2 and a month later was 6 (according to numeric rating scale). A percentage of 30% of patients had side effects, particularly paresthesia. There was a positive correlation that tended to be significant (p <0.10) between pain before the procedure and pain 1 month after the procedure and a statistically significant positive correlation (p <0.05) between pain with the procedure and pain 1 month after.
Conclusion: Genicular nerve block has contributed to the symptomatic relief of chronic knee pain in the short term and it seems that the intensity of pre-procedure pain and procedural pain are factors that influence the analgesic response to this intervention.
Downloads
References
Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, et al. Osteoarthritis. Lancet. 2015;386:376-87. doi: 10.1016/S0140-6736(14)60802-3.
Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med. 2019;8:1769. doi: 10.3390/jcm8111769.
Bedson J, Jordan K, Croft P. The prevalence and history of knee osteoarthritis in general practice: A case-control study. Fam Pract. 2005;22:103-8.
Nikolova V, Prakova G. Degenerative joint diseases (osteoartrtrosis) and quality of life. Trakia J Sc. 2018;16:180-3.
Moss P, Knight E, Wright A. Subjects with knee osteoarthritis exhibit widespread hyperalgesia to pressure and cold. PLoS One. 2016;11:e0147526. doi: 10.1371/journal.pone.0147526.
Dulay GS, Cooper C, Dennison EM. Knee pain, knee injury, knee osteoarthritis & work. Best Pract Res Clin Rheumatol. 2015;29:454-61. doi: 10.1016/j.berh.2015.05.005.
Ramlall Y, Andrion JJD, Cameron HU, Sawhney M. Examining pain before and after primary total knee replacement (TKR): A retrospective chart review. Int J Orthop Trauma Nurs. 2019;34:43-7. doi: 10.1016/j.ijotn.2019.04.001.
Hebets EA, Anderson A. Using cross-disciplinary knowledge to facilitate advancements in animal communication and science communication research. J Exp Biol. 2018;221:jeb179978. doi: 10.1242/jeb.179978.
Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566-72. doi: 10.1016/j.pain.2010.11.023.
Fonkoue L, Behets C, Kouassi JK, Coyette M, Detrembleur C, Thienpont E, et al. Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study. Surg Radiol Anat. 2019;41:1461-71. doi: 10.1007/s00276-
-02291-y.
Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical study of the innervation of anterior knee joint capsule: implication for imageguided intervention. Reg Anesth Pain Med. 2018;43:407-14. doi:
1097/AAP.0000000000000778.
Billesberger LM, Fisher KM, Qadri YJ, Boortz-Marx RL. Procedural treatments for knee osteoarthritis: a review of current injectable therapies. Pain Res Manag. 2020;2020:3873098. doi: 10.1155/2020/ 3873098.
Yasar E, Kesikburun S, Kilic C, Guzelkucuk U, Yazar F, Tan AK. Accuracy of ultrasound-guided genicular nerve block: a cadaveric study. Pain Physician. 2015;18:E899-904.
Doo-Hwan Kim M, Myung-Su Lee M, Sookyung Lee M, Syn-Hae Yoon M. A Prospective randomized comparison of the efficacy of ultrasound-vs fluoroscopy-guided genicular nerve block for chronic knee osteoarthritis. Pain Physician. 2019;22:139-46.
MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647-61.
Domingues L, Cruz EB. Adaptação cultural e contributo para a validação da escala Patient Global Impression of Change. [accessed Dez 2019] Available from http://www.ifisionline.ips.pt/
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152:2399-404.
Kim DH, Choi SS, Yoon SH, Lee SH, Seo DK, Lee IG, et al. Ultrasound-Guided Genicular Nerve Block for Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial of Local Anesthetic Alone or in Combination with Corticosteroid. Pain Physician. 2018;21:41-52.
CSPP. Standards for Basic Anesthetic Monitoring: American Society of Anesthesiologists; 2015 [accessed Dez 2019] Available from: https://www.asahq.org/standards-and-guidelines/standards-for-basicanesthetic-monitoring.
Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, et al. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015;68:73-9. doi: 10.1016/j.jclinepi.2014.08.009.
Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005;64:29-33.
Desai M, Bentley A, Keck WA, Haag T, Taylor RS, Dakin H. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis based on trial data. BMC Musculoskelet Disord. 2019;20:302. doi: 10.1186/s12891-019-2681-2.
Kidd VD, Strum SR, Strum DS, Shah J. Genicular nerve radiofrequency ablation for painful knee arthritis: the why and the how. JBJS Essent Surg Tech. 2019;9:e10-e. doi: 10.2106/JBJS.ST.18.00016.
Yilmaz V, Umay E, Gundogdu I, Aras B. The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study. Musculoskeletal Surgery. 2019 (in press). doi:
1007/s12306-019-00633-y
Downloads
Published
How to Cite
Issue
Section
License
Copyright statement
Authors must also submit a copyright statement (as seen below) on article submission.
To the Editor-in-chief of the SPMFR Journal:
The below signed author(s) hereby state that the article
________________________________________ (ref. MFR_________) is
an original unpublished work and all facts stated are a product of the author(s) investigation. This article does not violate any copyright laws or privacy statements. The author(s) also hereby confirm that there is no conflict of interest's issues in this article.
By submitting this article the author(s) agree that after publication all copyrights belong to the SPMFR Journal.
Signed by all authors
Date:
Names (capital letters):
Signatures:
The SPMFR Journal’s contents are follow a Creative Commons licence. After publication the authors can hand out the articles as long as the SPMFR Journal is credited.
