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Genicular Nerve Block: All You Need To Know
January 02, 2023

Chronic knee pain can negatively impact work, fitness, and daily activities. Even when seated or lying down, people with advanced knee arthritis often experience pain. It is important to note, however, that surgery is not an option for many people due to coexisting diseases or health concerns. The Premier Pain Centers of America specializes in diagnosing and treating chronic knee pain using cutting-edge techniques and procedures, including genicular nerve block and radiofrequency ablation. It is possible that these patients may decide to explore newer and more advanced non-surgical treatment options, such as nerve ablation.

What Is The Genicular Knee Nerve Block?

A genicular knee nerve block may be appropriate for patients who have failed to respond to chronic knee pain treatment. Based on the theory that blocking the nerve supply to a painful area may alleviate pain and restore function, this procedure is conducted. An articular branch of the femoral, common peroneal, saphenous, tibial, and obturator nerve innervates the knee joint. Gingival nerves are the branches that surround the knee joint. The genicular nerves can be easily reached with a needle under fluoroscopic guidance. In order to ascertain whether a diagnostic genicular nerve block will provide adequate relief, patients can undergo this procedure.

The Genicular nerve block is a procedure in which local anesthetic is injected through small needles to anesthetize (“block”) these nerves. Live x-ray guidance (fluoroscopy) is used to ensure accurate needle placement during the procedure. The procedure usually takes between five and ten minutes.

Does Genicular Nerve Block Cause Pain?

The genicular nerve block (GNB) procedure requires the use of a needle. There is usually only a mild discomfort associated with the injection for most people.

Is Genicular Nerve Block Associated With Any Risks?

  • Generally, GNB is a non-surgical procedure with few risks.
  • There have, however, been some reports of adverse side effects.
  • One of the most common risks is an allergy to the contrast agent used in x-rays as well as to the local anesthetic.
  • The injection site can also bleed, and there’s a low risk of infection, pain, redness, or swelling.
  • Rarely, nausea and dizziness can happen.

 

Reasons For Needing A Genicular Nerve Block?

A genicular nerve block serves two main purposes:

  • to relieve pain
  • to conduct diagnostic tests.

1- Control Of Pain

A genicular nerve block stops pain and numbs your nerves. Knee pain affects your life badly as it prevents you from walking and performing daily work. According to knee pain location chart either medial knee pain or posterior knee pain, both cases are painful. Hence the importance of genitourinary nerve block to relieve pain.The process is as follows:

  • Initially, we numb your skin at the injection site so that you will not feel any pain during the treatment.
  • Our next step is to administer the medication, which provides anesthesia to your painful nerves.
  • Here at our office, the process takes only five to ten minutes.
  • It is possible to feel relief within 15-30 minutes, however, the duration of this relief cannot be predicted.
  • People experience pain relief for a few hours, others experience pain relief for days or weeks, and some find that one injection permanently resolves their pain.

2- Diagnostic Tool

As genicular nerve blocks typically provide temporary relief, they are not generally recommended for long-term use. However, they are extremely helpful in identifying which nerve is causing your pain, so that we can treat it accordingly.

  • X-ray fluoroscopy is used to guide the needle to the correct spot, so we can target a specific nerve or branch of nerves.
  • If the injection stops or significantly reduces your pain, we will know we have identified the culprit and can proceed to treatment, often radiofrequency neurolysis.
  • During this procedure, heat energy is used to target and inactivate the offending nerve.

Genicular Nerve Blocks

Before the sensory branches (genicular nerves) enter the knee capsule, infiltration occurs around these sensory branches.

●      Indications

Symptoms related to chronic knee pain, total knee arthroplasty, or procedures associated with moderate to severe postoperative knee pain

●      Goal

 Anesthetic may be applied next to the genicular arteries (if visible) or at the junction of the epiphysis and diaphysis of the femur and tibia

Block Preparation

1- Equipment

●      Transducer

High-frequency, linear transducer

●      Needle

50-mm, 22-gauge, short-bevel needle

2- Local Anesthetic

●      Local anesthetic volume:

  • An amount of 4 to 5 milliliters per nerve
  • Bupivacaine and ropivacaine (0.25-0.5%) are recommended as long-lasting LAs in a volume of 4 to 5 mL per nerve.

Patient Positioning

A pillow is placed in the popliteal fossa to place the patient supine with the knee slightly flexed

Initial Transducer Position and Scanning Technique

●      SLGN

A transducer is placed in a coronal orientation over the lateral epicondyle of the femur and then moved proximally to visualize the metaphysis. At this level, the superolateral genicular artery can be seen between the deep fascia of the vastus lateralis and the femur

●      SMGN

A transducer is placed in a coronal orientation over the medial epicondyle of the femur. The transducer is moved slightly proximally in order to visualize the metaphysis of the bone just anterior to the adductor tubercle. Located between the vastus medialis deep fascia and the femur is the SMG artery.

●      ILGN

On the lateral side of the distal knee, the transducer is positioned in a coronal orientation. As soon as the lateral epicondyle of the tibia is identified, the transducer is moved distally to visualize the fibula’s head. The inferolateral genicular artery can be seen between the collateral ligament and the lateral condyle of the tibia.

●      IMGN

A transducer is placed in a coronal orientation over the medial condyle of the tibia and moved distally to visualize the metaphysis of the bone. Under the medial collateral ligament can be seen the inferomedial genicular artery.

Additionally, the recurrent peroneal nerve can be blocked by placing the transducer in a coronal orientation over the anterolateral side of the distal knee to visualize the junction of the tibial lateral epiphysis and diaphysis anterior to the fibula. The recurrent tibial artery can be seen superficially to the bone.

Needle Approach and Trajectory

The needle tip is advanced next to the vessel (if visible) until bony contact is felt. This may be done using an in-plane or out-of-plane approach. Alternately, the transducer can be rotated in a transverse orientation and the needle tip redirected toward the bone surface. Once the correct position has been confirmed, the remainder of the LA is injected.

The Effects Of A Genicular Nerve Block

Your doctor  should closely monitor your pain levels following your GNB and complete the post block pain diary over the following eight hours. Injections should relieve pain almost immediately and should last for up to eight hours. Patients who experience significant pain relief following genicular nerve ablation may be good candidates for this procedure, which cauterizes the nerves in the knee. Like GNB, GNA is performed using a needle under x-ray guidance without the need for surgery. It is possible to experience pain relief for up to 18 months following genicular nerve ablation.

Please contact us to schedule an appointment today.

Premier Pain Centers

The Premier Pain Center is one of the most prominent medical facilities in the United States dedicated to providing the highest level of medical care to patients suffering from severe muscle pain. Premier Pain specialists strive to provide comfort and peace to people as part of the purpose of our organization.

With our one-stop medical care center, we provide highly competent, skilled, and experienced physicians who are capable of treating painful conditions effectively. Our services include expert medical administration, interventional pain management, physical therapy, and therapy management.

Frequently Asked Questions

What Is The Duration Of A Knee Genicular Nerve Block?

Almost immediately after the injections, pain relief should become apparent and should last for approximately eight hours.

Is It Possible To Walk After A Genicular Nerve Block?

With the help of X-ray technology, we perform the nerve block in our office, which takes less than an hour. In most cases, a nerve block works quickly and gives you immediate relief, allowing you to walk out pain-free.

What Is The Procedure For Performing A Genicular Nerve Block?

By injecting local anesthetic through small needles, the Genicular nerves are anesthetized (“blocked”). In order to ensure proper needle placement, live x-ray guidance is used during the procedure (fluoroscopy). The procedure generally takes between five and ten minutes.