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

Ghai, Babita; Kumar, Muthu; Makkar, Jeetinder Kaur; Goni, Vijay

doi:10.3344/kjp.2022.35.2.183

Cited by 18 publications

(24 citation statements)

References 28 publications

(42 reference statements)

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“…Ghai et al ( 22) applied a single session ultrasound-guided genicular nerve blockade with a mixture of 4.5 mL of 0.5% bupivacaine and 1.5 mL (60 mg) of methylprednisolone to patients with osteoarthritis-related chronic knee pain. Improvement in pain severity as measured by NRS and functionality as assessed by WOMAC was demonstrated at a 3-month follow-up (22). Guler et al (23) showed that ultrasound-guided genicular nerve blockade with a total mixture of 5 ml of 2% lidocaine and 40 mg of triamcinolone, to patients with knee osteoarthritis has sustained improvement in pain, physical function, and physical capacity for up to 12 weeks.…”

Section: Discussionmentioning

confidence: 99%

Short- and mid-term clinical results of ultrasound-guided genicular nerve block in arthroplasty-related chronic postsurgical pain

Balta¹,

GÜLTEKİN²

2022

J. Exp. Clin. Med.

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One-third of patients experience knee arthroplasty-related chronic postsurgical pain (CPSP), and CPSP negatively affects all dimensions of quality of life. We aimed to evaluate the short- and mid-term clinical results and success of ultrasound-guided genicular nerve block in patients with knee arthroplasty-related CPSP. The secondary outcome aimed to evaluate the relationship between clinical success and the presence of neuropathic pain. This study is a retrospective chart review of patients with knee arthroplasty-related CPSP who were referred to a pain clinic and were unresponsive to conservative treatments. We obtained the clinical evaluations of the patients at one, three, and six months before and after the procedure from patient records. We evaluated pain intensity with a 10-point numerical rating scale (NRS), the effects of knee pain on function with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scoring system, and the presence of neuropathic pain with the Douleur Neuropathic Pain 4 Questions. We accepted the clinical success of the procedure as a 50% or more reduction in pain intensity. We evaluated a total of 21 patients. The therapy was successful in 13 (61.9%), 12 (57.1%), and 7 (33.3%) patients at the first, third, and sixth-month visits, respectively. There was a statistically significant difference between the NRS and WOMAC scores. At baseline, neuropathic pain was present in 61.9% (n = 13) of the patients, and its presence was not related to clinical success at the first, third, and sixth- month visits. Ultrasound-guided genicular nerve block relieves pain and improves short- and mid-term functionality for patients with knee arthroplasty-related CPSP. The study resulted in clinical success in two-thirds of the patients in the early period and one-third in the sixth month.

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Section: Discussionmentioning

confidence: 99%

Short- and mid-term clinical results of ultrasound-guided genicular nerve block in arthroplasty-related chronic postsurgical pain

Balta¹,

GÜLTEKİN²

2022

J. Exp. Clin. Med.

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“…Third, there are several different methods to assess CLAI, such as manual anterior drawer test, stress radiography, ultrasound examination or arthroscopy have been proved to be effective at discriminating CLAI. [24][25][26][27][28][29][30][31][32][33] However, we analyzed the PTFLCSA and PTFLT on MRI only.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

et al. 2023

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An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.

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“…The utility of prognostic nerve blocks at the site of pain generators has led to some debate in interventional pain practice [36]. Within the literature about recent outcome, treatment success rates are similar between studies that used prognostic genicular nerve blocks and those that did not [14,24,37,38]. Different results are seen regarding the predictive efficacy of response to prognostic block in determining genicular nerve RF treatment outcome in chronic knee pain.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation

Köse

Çelikel³

et al. 2022

Korean J Pain

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Background: Ultrasound-guided genicular nerve radiofrequency (RF) procedures are of interest in the management of chronic knee pain. A wide variety of demographic, clinical, and procedural characteristics can affect treatment success. This study aimed to determine predictive factors to provide superior treatment outcomes. Methods: The demographic, clinical, and technical data of patients who received genicular nerve RF for knee pain between September 2016 and September 2021 were evaluated. A positive outcome was defined as at least 50% pain relief on a pain score for at least 6 months. Logistic regression analysis was performed to determine the factors associated with a successful response to genicular RF. Results: Among 206 patients who underwent genicular RF, 62% of the patients reported successful outcomes at 6 months. In the multivariate model, targeting 5 nerves (odds ratio [OR], 6.184; 95% confidence interval [CI], 2.291-16.690; P < 0.001) was the most significant predictor of successful outcomes. Multivariable logistic regression analysis showed that prognostic genicular nerve block with a 50% cut-off value (OR, 2.109; 95% CI, 1.038-4.287; P = 0.039), no opioid use (OR, 2.753; 95% CI, 1.405-5.393; P = 0.003), and depression (OR, 0.297; 95% CI, 0.124-0.713; P = 0.007) were the predictive factors significantly associated with response to genicular RF. Conclusions: Clinical and technical factors associated with better treatment outcomes were ultimately targeting more nerves, performing prognostic block, no opioid use, and no depression. These results are expected to be considered when selecting patients for genicular RF.

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

Cited by 18 publications

References 28 publications

Short- and mid-term clinical results of ultrasound-guided genicular nerve block in arthroplasty-related chronic postsurgical pain

Short- and mid-term clinical results of ultrasound-guided genicular nerve block in arthroplasty-related chronic postsurgical pain

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation

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